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Robot-assisted laparoscopic ileal ureter
Joseph R Wagner1, Megan O Schimpf, Jeffrey L Cohen
1Department of Urology, Hartford Hospital/University of Connecticut, Hartford, Connecticut, USA.
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|September 4, 2008
Summary
Robot-assisted surgery successfully replaced a ureter in a patient with a solitary kidney, cysteine stones, and strictures. This minimally invasive technique shows excellent long-term results for complex ureteral reconstruction.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- A patient presented with a solitary kidney, recurrent ureteral strictures, and cysteine stones, necessitating complex reconstructive surgery.
- Traditional open surgical approaches for ureteral strictures can be associated with significant morbidity.
Observation:
- A robot-assisted laparoscopic ureterectomy was performed, involving the removal of the diseased ureter segment.
- An ileal ureter was constructed and anastomosed to the renal pelvis and bladder using the robotic system.
- The procedure utilized a transperitoneal, 4-port approach with an extracorporeal bowel anastomosis.
Findings:
- The surgery achieved a 9-hour operative time with minimal blood loss.
- Postoperative cystography confirmed patent ileal ureter anastomoses without any signs of urine extravasation.
- The patient experienced a short hospital stay of 5 days.
Implications:
- Robot-assisted laparoscopic ileal ureter replacement is a feasible and effective treatment option for complex ureteral pathology.
- This minimally invasive approach offers excellent long-term functional outcomes, as demonstrated by the patient's 48-month follow-up.
- The technique provides a valuable alternative for patients with solitary kidneys and recurrent ureteral strictures, potentially reducing recovery time and complications.