Robot-Assisted Ureteroneocystostomy: Technique and Comparative Outcomes

Abstract

RUNC provides excellent outcomes with shorter hospital stay, less narcotic pain requirement, and decreased blood loss when compared with the open procedure. Advantages of the robotic platform for dissection and suturing can be useful for complex minimally invasive urologic reconstructive procedures.

Open, Laparoscopic, and Robotic Ureteroneocystotomy for Benign and Malignant Ureteral Lesions: A Comparison of Over 100 Minimally Invasive Cases

“…A similar study by Isac et al reviewed a 10-year experience of 25 and 41 patients who underwent RAL UNC and open UNC, respectively. 12 Their analysis revealed no difference in baseline demographics (age, gender, BMI, ASA, stone disease etiology, laterality, indication) or in surgical technique distribution (primary UNC vs tapered UNC, psoas hitch, and boari flap). Predictably, the RAL UNC cohort did require a longer operative time (79 minutes) and lower EBL (and decrease in Hct) compared to the open UNC cohort.…”

“…Robotic UNC was performed by five different surgeons in an analogous manner to the LAP approach with small modifications similar to prior reports. 11,12 The surgical approach was based on individual surgeon preference.…”

“…Similarly, the robot-assisted laparoscopic (RAL) approach has been applied to this procedure with similar enthusiasm, 6-10 with more recent series suggesting similar improvements in EBL, morphine requirements, and LOS over the open approach. 11,12 However, such reports are frequently limited by a small number of cases with short-term follow-up. Furthermore, no report has compared the LAP approach to the RAL approach.…”

Robotic-Assisted Ureteral Re-implantation: A Case Series

“…Although operative times and length of stay were greater, these differences may be due to differences in technique (refluxing versus nonrefluxing) and healthcare systems (United States versus Europe). Perhaps the largest series of distal ureteral surgery to date for benign disease was reported by Isac et al 12 We similarly report on our early experience with RAUR in a series of 13 patients involving 14 re-implants at a single institution. To the best of our knowledge, this series represents the second largest single-institution experiences with adult robotic mid-/distal ureteral reconstruction for purely benign distal ureteral disease.…”

“…This is comparable to other published case series, which ranged from 0% to 55%. [10][11][12][13][14][15][16][17] Two patients required a blood transfusion as a result of postoperative bleeding, presumably related to cold dissection through extensive omental adhesions. Given that one of the perceived benefits of robotic surgery is decreased blood loss, the incidence of postoperative blood transfusions in our early experience with RAUR is somewhat disconcerting.…”