Robot-assisted laparoscopic ureteral reimplant

Abstract

Introduction: Open ureteral reimplant has been the gold standard for management of lower ureteric strictures. With the widespread acceptance of robotic surgery, robotic-assisted laparoscopic ureteral reimplant (RALUR) is becoming the preferred choice for performing ureteral reimplant. We present our single-institution and single-surgeon experience of performing RALUR. Materials and Methods: We performed a retrospective analysis of 40 patients who underwent RALUR at our institute in the last 5 years. Demographic data were recorded along with presenting complaint and diagnosis. Intraoperative variables included operative and docking time, blood loss, intraoperative complications, technique, and procedure performed. Postoperative data that were analyzed included complications, hospital stay, and outcomes. Patient satisfaction score was calculated using a numerical scale of points 1–6. Results: The mean age of patients was 31.5 ± 9.8 years (r = 4–45). Male: female ratio was 3:5. The most common presenting symptom was flank pain, and the most common etiology was iatrogenic strictures in adults and congenital vesicoureteral reflux in children. The mean operative time and blood loss were 135.3 ± 45.1 min (r = 84–221) and 67.7 ± 31.4 ml (r = 32–118), respectively. There were no intraoperative complications and nil conversion to open surgery. The mean length of hospital stay was 4.5 ± 2.3 days (r = 3–9). Radiographic success was achieved in 41 out of 44 ureters. Eighty-five percent of the patients were completely satisfied with robotic approach and its outcomes. Conclusion: RALUR is a minimally invasive, safe, feasible, less morbid technique with good outcome.

Robotic approach to the uretero‐vesical junction in children: An international multicentric retrospective study

“…The most affected age group by urological diseases treated with robot-assisted surgery was 2.5 years, 8,10 with no statistically significant differences in terms of sex; different results were obtained from our analysis in which the mean age at surgery was 6 years with a median of 8 years old.…”

“…Robot assisted approach recently started to be chosen as the best option to treat uretero-vesical junction malformations in children by both paediatric surgeons and urologists instead of open and laparoscopic ones surgeries. 10 Open ureteral reimplantation is seen to be associated with increased intraoperative blood loss, increased postoperative analgesic need, longer hospitalisation and worse cosmesis than minimally invasive surgery. 11 On the other hand, conventional laparoscopy is limited by two-dimensional (2D) vision, a lower learning curve and the necessity to change port placement.…”

“…18 In Tyagi et al, for example, there was no evidence of recurrent reflux, persistent obstruction, or pyelonephritis complications following surgery at all. 10 If we consider all the associated post operative complications, the success rate of our series is 76.9% lower than the median success rate reported in other retrospective series of 81.1% 18 or 88% 19 ; but if we define the success of the procedure as the resolution of symptoms, downgrading of VUR and/or improvement of radiographic obstruction, our success rate is comparable to that reported in Literature with a median of 82.4 20 and a range of 77%-100%. 10 Robotic ureteral reimplantation and uretero-nephrectomies have brought logistical challenges in terms of port placement and robot positioning.…”

“…A third working port could be to facilitate renal surgery. 10 Finally, the most important conclusion: Robotic urological surgery allows paediatric surgeons to work on both upper and lower ureteral ends without changing robotic ports.…”

“…MOLINARO ET AL.performed in any patient. The mean duration of antibiotic therapy was 5 days[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] with a median of 5 and a SD of 4.47. In one of the three centres, only one-shot prophylactic therapy was prescribed.The mean length of postoperative hospital stay was 4 days, with a median of 4 days and a SD of 3.32.Outcomes were analysed in terms of relapse of symptoms, persistent VUR and readmission to hospital.…”