Robotic Ureter Reimplantation After Urinary Diversion

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Benign ureterointestinal anastomotic stricture (UIAS) is a complication of radical cystectomy with urinary diversion (UD).
• Endourologic treatments have low success rates (26%-50%), while open surgery has high success rates (80%-91%) but significant morbidity.
• Robotic surgery offers a minimally invasive alternative with comparable outcomes to open surgery for UIAS reconstruction.

Purpose of the Study:

• To demonstrate a robotic technique for UIAS revision.
• To combine the effectiveness of open surgery with the reduced morbidity of minimally invasive approaches.

Main Methods:

• A step-by-step demonstration of robotic UIAS revision using standard Da Vinci instruments.
• Identification of stricture via indocyanine green injection.
• Ureter excision and spatulation, followed by reanastomosis with 4-0 Stratafix suture.
• Frozen section analysis to exclude malignancy.

Main Results:

• Mean operative time: 122 minutes (range 80-160).
• Mean blood loss: 42 mL (range 50-100).
• No malignancy found on frozen section.
• No postoperative complications > Clavien-Dindo grade 3.
• Median hospital stay: 4 days (range 2-7).
• No recurrence during a mean follow-up of 23 months.

Conclusions:

• Robotic UIAS revision is a viable, minimally invasive alternative to open surgery.
• Outcomes are comparable to open surgery.
• Benefits include reduced blood loss and shorter hospital stays.