Robotic ureteral reimplantation for uretero-enteric anastomotic strictures in different urinary diversions

Giuseppe Simone1, Carlos Fay2, Daniel Freitas2, Sameer Chopra2, Leonardo Misuraca1, Gabriele Tuderti1, Mariaconsiglia Ferriero1, Francesco Minisola1, Salvatore Guaglianone1, Inderbir Singh Gill2, Andre Berger2, Mihir Desai2, Alvin Goh3, Monish Aron2
  • 1 Istituto Nazionale Tumori "Regina Elena", Unità di Urologia (Roma)
  • 2 Keck School of Medicine, University of Southern California, USC Institute of Urology ( Los Angeles)
  • 3 Methodist Hospital, Dept. of Urology (Houston)

Abstract

In this video we describe the techniques and outcomes of robotic ureteral reimplantation for ureteroenteric anastomotic strictures in different UDs.
From April 2013 to July 2016 12 patients underwent robotic ureteral reimplantation in three tertiary referral centers.
Out of 12 patients, 7 had orthotopic neobladder, 4 ileal conduit and 1 Indiana pouch. All patients had prior robot assisted radical cystectomy and all but one had intracorporeal UD.
Surgical steps include a careful ureteral dissection on the surface of the ureter/s to avoid injurying the iliac vessels, spatulation of the ureters, JJ stent insertion and finally uretero-ileal anastomosis.
Three cases (one ileal conduit, one neobladder and one Indiana Pouch) are demonstrated in the video.
Baseline, perioperative and functional outcomes data are reported.
Mean stricture length was 2 cm (range 0.5-3), median operative time was 201 minutes (83-310) and median length of stay was 2 days (2-12).
Intraoperative blood loss was negligible. Four patients experienced a Clavien grade 2 complication (urinary tract infection requiring antibiotics). At a mean follow-up of 1-yr no patient developed recurrence.
The suboptimal success rate of endoscopic treatment, the minimally invasiveness of robotic surgery and the high success rate of robotic repair may contribute to an increased adoption of this surgical option in the near future.

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