Single-Surgeon Experience With Robot-Assisted Ureteroneocystostomy for Distal Ureteral Pathologies in Adults

다국어 초록 (Multilingual Abstract)

Purpose: To demonstrate our technical approach for robot-assisted ureteroneocystostomy (R-UNC) for benign and malignant distal ureteral pathologies.
Materials and Methods: Between January 2009 and January 2013, a total of 10 patients underwent R-UNC in the distal ureter by a single surgeon. Indications for R-UNC were as follows: idiopathic (3), fistula (2), iatrogenic (2), malignancy (2), and chronic vesicoureteral reflux (1).
Results: Tension-free anastomosis was attained in all 10 R-UNC procedures. A psoas hitch was performed in 6/10 cases (60%). Intravesical and extravesical reimplantations were completed in 5/10 (50%) and 5/10 cases (50%), respectively. A nonrefluxing ureter was constructed in 2/10 cases (20%). The patients’ mean age was 52.9±16.6 years, their mean body mass index was 30.8±6.3 kg/m2, the mean operative time was 211.7±69.3 minutes, mean estimated blood loss was 102.5±110.8 mL, and mean length of stay was 2.8±2.3 days. There were no intraoperative complications. There was one Clavien- Dindo grade I and one Clavien-Dindo grade II postoperative complication. The mean postoperative follow-up duration was 28.5±15.5 months. Two patients had recurrence of ureteral strictures at 3 months postoperatively and were managed successfully with balloon dilation.
Conclusions: Our technique for R-UNC demonstrates good perioperative outcomes. However, underlying periureteral inflammation and pelvic adhesions may predispose patients for stricture recurrence after R-UNC.

참고문헌 (Reference)

1 Paquin AJ Jr, "Ureterovesical anastomosis: the description and evaluation of a technique" 82 : 573-583, 1959

2 Stief CG, "Ureteric reconstruction" 91 : 138-142, 2003

3 Rassweiler JJ, "Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques" 51 : 512-522, 2007

4 Benson MC, "Ureteral reconstruction and bypass: experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation" 143 : 20-23, 1990

5 Rassweiler J, "Role of laparoscopy in reconstructive surgery" 20 : 471-482, 2010

6 Laungani R, "Robotic-assisted ureterovaginal fistula repair: report of efficacy and feasiblity" 18 : 731-734, 2008

7 Patil NN, "Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation" 72 : 47-50, 2008

8 Kozinn SI, "Robotic versus open distal ureteral reconstruction and reimplantation for benign stricture disease" 26 : 147-151, 2012

9 Ahlering TE, "Robotic versus laparoscopic radical prostatectomy" 1 : 58-59, 2004

10 Lanfranco AR, "Robotic surgery: a current perspective" 239 : 14-21, 2004

11 Uberoi J, "Robot-assisted laparoscopic distal ureterectomy and ureteral reimplantation with psoas hitch" 21 : 368-373, 2007

12 Schimpf MO, "Robot-assisted laparoscopic distal ureteral surgery" 13 : 44-49, 2009

13 Schimpf MO, "Robot-assisted laparoscopic Boari flap ureteral reimplantation" 22 : 2691-2694, 2008

14 Menon M, "Potency following robotic radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques" 174 : 2291-2296, 2005

15 Ehrlich RM, "Laparoscopic vesicoureteroplasty in children: initial case reports" 43 : 255-261, 1994

16 Reddy PK, "Laparoscopic ureteroneocystostomy" 152 (152): 2057-2059, 1994

17 Lakshmanan Y, "Laparoscopic extravesicular ureteral reimplantation for vesicoureteral reflux: recent technical advances" 14 : 589-593, 2000

18 Asimakopoulos AD, "Laparoscopic extravesical ureteric re-implantation" 108 : 1918-1932, 2011

19 Hemal AK, "Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies" 76 : 1387-1393, 2010

20 Williams SK, "Expanding the horizons: robot-assisted reconstructive surgery of the distal ureter" 23 : 457-461, 2009

21 Castillo OA, "Early experience with the laparoscopic boari flap at a single institution" 173 : 862-865, 2005

22 Phillips EA, "Current status of robot-assisted laparoscopic ureteral reimplantation and reconstruction" 13 : 190-194, 2012