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      Robot-assisted ureteral reconstruction – current status and future directions

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          Abstract

          Robotic surgery in the treatment in certain urological diseases has become a mainstay. With the increasing use of the robotic platform, some surgeries which were historically performed open have transitioned to a minimally invasive technique. Recently, the robotic approach has become more utilized for ureteral reconstruction. In this article, the authors review the surgical techniques for a number of major ureteral reconstuctive surgeries and briefly discuss the outcomes reported in the literature.

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          Use of indocyanine green during robot-assisted ureteral reconstructions.

          Ziho Lee, Blake Moore, Laura Giusto … (2015)
          Although there are reports of robot-assisted ureteral reconstructions (RURs) with excellent safety and efficacy, the procedures remain technically challenging. In the robotic setting the surgeon must rely on visual cues in the absence of tactile feedback. Indocyanine green (ICG) is a dye that can be visualized under near-infrared fluorescence (NIRF).
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            Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation.

            Poonam Patil, Robin Patel, Bala Sundaram … (2008)
            To report the collective experience of three multinational institutions with the use of robotics to evaluate and treat complex distal ureteral obstruction. A total of 12 patients from The Ohio State University, Columbus, Ohio; Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium; and Hospital Sultanah Aminah, Kuala Lumpur, Malaysia underwent robotic-assisted laparoscopic ureteral reimplantation between August 2004 and July 2006. The indications for ureteral reimplantation included ureteral stricture (n = 10) and ureterovaginal fistula (n = 2). Nine patients had pathology on the left side and 4 patients had right-sided disease. Surgery was performed by three experienced laparoscopic robotic surgeons with the daVinci Surgical System. The mean patient age (range) was 41.3 years (19 to 67 years). The mean operative time was 208 minutes (80 to 360 minutes). The mean robot time was 173 minutes (75 to 300 minutes). The mean estimated blood loss was 48 mL (45 to 100 minutes). The mean length of hospitalization was 4.3 days (2 to 8 days). All the procedures were completed successfully robotically without open conversion. There were no intraoperative or postoperative complications. Postoperative intravenous urography and Mercapto Acetyl TriGlycine 3 showed normal findings in 10 patients and a mild residual hydronephrosis in 2 patients. After a mean follow-up of 15.5 months, all patients were asymptomatic of their initial disease state. This multi-institutional, multinational experience illustrates that ureteral reimplantation with psoas hitch can be performed safely and effectively to treat lower tract ureteral obstruction.
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              When and how to use buccal mucosal grafts in adult bulbar urethroplasty.

              Rajendra A. Morey, J McAninch (1996)
              To evaluate the efficacy of buccal mucosa in the repair of adult urethral stricture disease, we report our experience with its use as a nontubularized onlay graft during bulbar urethral reconstruction. From June 1993 to January 1996, 75 men underwent anterior urethral reconstruction for stricture disease. Single-stage urethroplasty with an onlay patch graft of buccal mucosa was performed in 13 patients with complex, refractory strictures of the bulbar urethra. In all cases, a two-team approach was used in which one team harvested the graft from the mouth while the perineal team simultaneously exposed and calibrated the stricture. The length of buccal mucosa ranged from 3.5 to 17 cm (average length 6.2). In 8 patients, other reconstructive techniques were used concomitantly, including fasciocutaneous penile flap or stricture excision and primary anastomosis, depending on the length and severity of the scarred area. Median follow-up time was 18 months. Excellent results were obtained in all 13 patients, and none has required urethral dilation or instrumentation subsequently. Operative time was significantly less than with other forms of substitution urethroplasty. Excellent results can be expected when buccal mucosa is used for urethral substitution in men with refractory bulbar strictures. For patients with long or dense strictures, buccal mucosal grafts may easily be combined with other reconstructive techniques. In patients with less complex stricture disease, the reduced operative time of this two-team approach may be beneficial.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Urol Ann
                Journal ID (iso-abbrev): Urol Ann
                Journal ID (publisher-id): UA
                Title: Urology Annals
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-7796
                ISSN (Electronic): 0974-7834
                Publication date (Print): Jan-Mar 2018
                Volume: 10
                Issue: 1
                Pages: 7-14
                Affiliations
                [1]Department of Urology, Glickman Urology and Kidney Institute, Cleveland, Ohio, USA
                [1 ]Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA
                Author notes
                Address for correspondence: Dr. Nitin Yerram, Department of Urology, Glickman Urology and Kidney Institute, Cleveland Clinic Foundation, 500 Euclid Avenue, Cleveland, Ohio 44195, USA. E-mail: yerramn@ 123456ccf.org
                Article
                Publisher ID: UA-10-7
                DOI: 10.4103/UA.UA_94_17
                PMC ID: 5791461
                PubMed ID: 29416268
                SO-VID: 78a2a5d4-90c6-4af8-98b8-62e047ea9e15
                Copyright © Copyright: © 2018 Urology Annals
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 18 June 2017
                Date accepted : 17 August 2017
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Urology
                Keywords: robotic surgery,robotic ureteral reconstruction,robotics,ureteral injury,ureteral reconstruction
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: robotic surgery, robotic ureteral reconstruction, robotics, ureteral injury, ureteral reconstruction

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