Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Abstract

Background Complete intracorporal robotic ileal ureteric replacement is challenging. We aim to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. Methods From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage in imaging examination. Results All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20(12–30) cm. The median operative time was 248(170–450) min, the median estimated blood loss was 50(10–200) mL, and the median postoperative hospital stay was 7 (5–27) days. At a median follow-up of 16(13–28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complication including 4 cases of urinary infection (Grade I), 1 case of incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II) and 1 case of incision infection (Grade IIIb). Conclusions Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures.

Total intracorporeal laparoscopic ileal ureter replacement in a single position for ureteral stricture based on membrane anatomy

“…Next, in terms of indications for surgery, the main surgical indication for TILIUR is patients with bilateral long or multiple ureteral strictures, which is similar to the surgical indications reported in the current literature 15 . IUR combined with abdominal wall stoma is recommended for patients with bilateral long or multiple ureteral strictures accompanied by bladder dysfunction, such as urinary incontinence, or preoperative creatinine greater than 2 mg/dl.…”

“…Thereare limited TILIUR reports for treating postoperative cervical cancer radiotherapy-induced ureteral strictures. Gözen AS et al 12 reported 40 cases of TILIUR in 2020, one of which was for ureteral strictures caused by cervical surgery followed by radiotherapy, and the mean operative time in this series was 335 (150-680) minutes, with a mean estimated blood loss of 221 (50-400) ml; Li B et al 14 reported two cases in 2021, with operative times of 420 min and 410 min per patient and an estimated blood loss of 120 ml and 100 ml, respectively; Li X et al 15 reported 15 cases of robotic-assisted total intracorporeal robot-assisted ileal ureter replacement (RA-IUR) in 2023, with 7 patients treated with unilateral RA-IUR and 8 patients treated with bilateral RA-IUR, with a mean operative time of 261.8 min (183-381 min) and an estimated blood loss of 64.7 ml (30-100 ml), including 7 patients who had surgery for cervical cancer plus radiotherapy. Our series were all in this category, with a mean operative time of 458 min (385-575 min) and an estimated blood loss of 158 ml (50-400 ml).…”