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Robot-assisted surgery for benign ureteral stenosis: Experience and outcomes from four tertiary care institutions
PE86 Robot-assisted surgery for benign ureteral stenosis: Experience and outcomes from four tertiary care institutions Lista G.1, Buffi N.M.2, Lughezzani G.2, Hurle R.2, Lazzeri M.2, Taverna G.2, Bozzini G.2, Bertolo R.3, Porpiglia F.3, Fossati N.1, Gandaglia G.1, Larcher A.1, Suardi N.1, Montorsi F.1, Guazzoni G.2, Mottrie A.4 1
Irccs Ospedale San Raffaele, Dept. of Oncology and Urology, Milan, Italy, 2Humanitas Clinical and Research Center, Dept. of Urology, Rozzano, Milan, Italy, 3San Luigi Gonzaga Hospital, Dept. of Urology, Orbassano, Italy, 4Onze-Lieve-Vrouw Hospital, Dept. of Urology, Aalst, Belgium INTRODUCTION & OBJECTIVES: Minimally invasive treatment of benign ureteral stenosis is still challenging for its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate the outcomes of robotic ureteral repair in a multi-institutional cohort of patients treated for uretero-pelvic junction obstruction (UPJO) and ureteral stricture (US) at four tertiary referral centres. MATERIAL & METHODS: This retrospective study reported data from 183 patients treated with standard robot-assisted pyeloplasty, robotic uretero-ureterostomy and robot-assisted ureteral reimplantation at four high volume centers from January 2006 to September 2014. Robotic pyeloplasty, robot-assisted uretero-ureterostomy were performed according the previously reported surgical techniques. For robot-assisted ureteral re-implantation, a dorsal lithotomy and Trendelenburg position (20°) was used in all cases. Two 8-mm robotic trocars, a 12-mm robotic camera port at the umbilicus and two assistant ports (5 and 12 mm) were used. The stenotic part of the ureter was identified and transected. After careful dissection of the bladder , a tension free vesico-ureteral anastomosis with two running sutures was completed on a double-J stent. A psoas-bladder hitch or a Boari flap was performed in cases of inadequate simple bladder mobilization. Pre-operative, intraoperative, postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. RESULTS: No cases of robot-assisted uretero-ureterostomy and reimplantation needed surgical conversion while 2.8% of pyeloplasty were not completed robotically. Median operative time was 120,150 and 165 min for robot-assisted pyeloplasty, robot-assisted uretero-ureterostomy and re-implantation respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and were mostly low grade complications . High grade complication rate was 2.2% (n=4). At a median follow-up time of 24 months, the overall success rate was higher than 90% for all the procedures. CONCLUSIONS: Robotic surgery for benign ureteral stenosesis is safe and effective with limited risk of high-grade complications and good intermediate-term results. Robotic technology overcomes the steep learning curve of laparoscopic approach providing precise suturing and dissection.
Eur Urol Suppl 2016; 15(7):301
Irccs Ospedale San Raffaele, Dept. of Oncology and Urology, Milan, Italy, 2Humanitas Clinical and Research Center, Dept. of Urology, Rozzano, Milan, Italy, 3San Luigi Gonzaga Hospital, Dept. of Urology, Orbassano, Italy, 4Onze-Lieve-Vrouw Hospital, Dept. of Urology, Aalst, Belgium INTRODUCTION & OBJECTIVES: Minimally invasive treatment of benign ureteral stenosis is still challenging for its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate the outcomes of robotic ureteral repair in a multi-institutional cohort of patients treated for uretero-pelvic junction obstruction (UPJO) and ureteral stricture (US) at four tertiary referral centres. MATERIAL & METHODS: This retrospective study reported data from 183 patients treated with standard robot-assisted pyeloplasty, robotic uretero-ureterostomy and robot-assisted ureteral reimplantation at four high volume centers from January 2006 to September 2014. Robotic pyeloplasty, robot-assisted uretero-ureterostomy were performed according the previously reported surgical techniques. For robot-assisted ureteral re-implantation, a dorsal lithotomy and Trendelenburg position (20°) was used in all cases. Two 8-mm robotic trocars, a 12-mm robotic camera port at the umbilicus and two assistant ports (5 and 12 mm) were used. The stenotic part of the ureter was identified and transected. After careful dissection of the bladder , a tension free vesico-ureteral anastomosis with two running sutures was completed on a double-J stent. A psoas-bladder hitch or a Boari flap was performed in cases of inadequate simple bladder mobilization. Pre-operative, intraoperative, postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. RESULTS: No cases of robot-assisted uretero-ureterostomy and reimplantation needed surgical conversion while 2.8% of pyeloplasty were not completed robotically. Median operative time was 120,150 and 165 min for robot-assisted pyeloplasty, robot-assisted uretero-ureterostomy and re-implantation respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and were mostly low grade complications . High grade complication rate was 2.2% (n=4). At a median follow-up time of 24 months, the overall success rate was higher than 90% for all the procedures. CONCLUSIONS: Robotic surgery for benign ureteral stenosesis is safe and effective with limited risk of high-grade complications and good intermediate-term results. Robotic technology overcomes the steep learning curve of laparoscopic approach providing precise suturing and dissection.
Eur Urol Suppl 2016; 15(7):301