Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

Abstract

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006).No differences were found in terms of operative time and post-operative complications. After a median followup of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.

Expanding the indications of robotic surgery in urology: A systematic review of the literature

“…On review of the literature we identified 17 studies ( Table 5 [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] ) evaluating distal ureteric reconstructive surgery, with institutions presenting their experience using a number of differing techniques including uretero-ureterostomy and uretero-neocystostomy (often with adjunct procedures such as Boari flap formation or Psoas hitch).…”

“…Comparisons with laparoscopic and open ureteric reconstruction have been made. Baldie et al [73] and Schiavina et al [82] , both performed non-randomised comparisons of pure laparoscopic against robot-assisted ureteric reconstruction. Using similar reconstructive techniques, short- and long-term complications were similar between both groups, although RAS was associated with a lower operative time, blood loss, and LOS [73] , [82] .…”

“…Baldie et al [73] and Schiavina et al [82] , both performed non-randomised comparisons of pure laparoscopic against robot-assisted ureteric reconstruction. Using similar reconstructive techniques, short- and long-term complications were similar between both groups, although RAS was associated with a lower operative time, blood loss, and LOS [73] , [82] . In similar retrospective non-randomised comparisons of RAS vs open surgery, RAS was associated with less blood loss and LOS, whilst operative durations, and short- and long-term complication rates were similar in both groups [72] , [74] .…”

Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience

“…The only high-grade late complication recorded was ureteral stenosis, which is one of the most common late complication after RC. Despite open surgery being still considered as the gold standard, its management could still be ‘less-invasive’ with good surgical results, as reported by other authors [33, 34], without adding further surgical distress.…”

Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults

“…Very recently, a multicenter study compared the robotic and laparoscopic ureteral stenosis repair operations, and no significant differences were found in terms of the perioperative parameters between the 2 groups. The robotic group yielded 2 stenosis recurrences and the laparoscopic group showed no case of recurrence [24] . However, the study included a relatively small number of patients and the surgical procedures performed were different between groups.…”