1
|
Shrivastava N, Bhargava P, Jain P, Choudhary GR, Jena R, Singh M, Navriya S, Madduri VKS, Bhirud DP, Sandhu AS. Robot-assisted ureteric reconstructive surgeries for benign diseases: Initial single-center experience with point of technique. Urologia 2024; 91:357-363. [PMID: 38345047 DOI: 10.1177/03915603241229144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
INTRODUCTION We present our initial experience with robot-assisted reconstructive surgeries with the Da Vinci Xi robotic system for benign ureteric pathologies. MATERIALS AND METHODS This is a retrospective review of prospectively collected data of patients who underwent robot-assisted reconstructive procedures for benign diseases of the ureter at our department from April 2018 to November 2022. Demographic and perioperative details were recorded. Patients were followed up and surgical success was evaluated on the basis of symptomatic, functional, and radiological improvement. RESULTS A total of 34 patients underwent robot-assisted reconstructions for benign ureteric pathologies by various techniques. Mean age, body mass index (BMI), hospital stay and follow-up duration were 36 years, 24.1 kg/m2, 5.29 days, and 7.08 months respectively. Procedures included pyeloplasty in eight, primary ureteroneocystostomy (UNC) in seven, Psoas hitch UNC in five, Boari flap UNC in six, Ureteroureterostomy in four, ureterocalicostomy in two and ileal ureteral transposition in two patients. Mean docking time, total operative time, and estimated blood loss were 31.5 min, 178 min, and 64.3 ml, respectively. All patients had radiologic or functional improvement on follow-up after 6 months. CONCLUSION Robot-assisted reconstructive surgery for benign ureteric and bladder pathologies imparted excellent short-term outcomes without major complications with all the advantages of a minimally invasive approach.
Collapse
Affiliation(s)
- Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyank Bhargava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pritesh Jain
- Department of Urology, Preksha Hospital, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shivcharan Navriya
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
2
|
Ziewers S, Dotzauer R, Thomas A, Brandt MP, Haferkamp A, Frees S, Zugor V, Kajaia D, Labanaris A, Kouriefs C, Radu C, Radavoi D, Jinga V, Mirvald C, Sinescu I, Surcel C, Tsaur I. Robotic-assisted vs. open ureteral reimplantation: a multicentre comparison. World J Urol 2024; 42:194. [PMID: 38530438 DOI: 10.1007/s00345-024-04875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/09/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Open ureteral reimplantation is considered the standard surgical approach to treat distal ureteral strictures or injuries. These procedures are increasingly performed in a minimally invasive and robotic-assisted manner. Notably, no series comparing perioperative outcomes and safety of the open vs. robotic approach are available so far. METHODS In this retrospective multi-center study, we compared data from 51 robotic ureteral reimplantations (RUR) with 79 open ureteral reimplantations (OUR). Both cohorts were comparatively assessed using different baseline characteristics and perioperative outcomes. Moreover, a multivariate logistic regression for independent predictors was performed. RESULTS Surgery time, length of hospital stay and dwell time of bladder catheter were shorter in the robotic cohort, whereas estimated blood loss, postoperative blood transfusion rate and postoperative complications were lower than in the open cohort. In the multivariate linear regression analysis, robotic approach was an independent predictor for a shorter operation time (coefficient - 0.254, 95% confidence interval [CI] - 0.342 to - 0.166; p < 0.001), a lower estimated blood loss (coefficient - 0.390, 95% CI - 0.549 to - 0.231, p < 0.001) and a shorter length of hospital stay (coefficient - 0.455, 95% CI - 0.552 to - 0.358, p < 0.001). Moreover, robotic surgery was an independent predictor for a shorter dwell time of bladder catheter (coefficient - 0.210, 95% CI - 0.278 to - 0.142, p < 0.001). CONCLUSION RUR represents a safe alternative to OUR, with a shorter operative time, decreased blood loss and length of hospital stay. Prospective research are needed to further define the extent of the advantages of the robotic approach over open surgery.
Collapse
Affiliation(s)
- Stefanie Ziewers
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Frees
- Department of Urology and Pediatric Urology, University Medicine Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Vahudin Zugor
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | - David Kajaia
- Clinic for Urology, Pediatric Urology and Robot-Assisted Minimally Invasive Urology, Clinical Center Bamberg, Bamberg, Germany
| | | | | | - Cosmin Radu
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Daniel Radavoi
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Viorel Jinga
- "Prof. Dr. Theodor Burghele" Clinical Hospital, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Mirvald
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Ioanel Sinescu
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Cristian Surcel
- Center of Urologic Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy Carol Davila, 050474, Bucharest, Romania
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| |
Collapse
|
3
|
Saini S, Deveshwar SP, Hemal AK. Narrative review of nephron-sparing surgical management of upper tract urothelial carcinoma: is there a role for distal ureterectomy, segmental ureterectomy, and partial nephrectomy. Transl Androl Urol 2024; 13:156-164. [PMID: 38404550 PMCID: PMC10891386 DOI: 10.21037/tau-23-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/07/2023] [Indexed: 02/27/2024] Open
Abstract
Background and Objective Upper tract urothelial carcinoma (UTUC) is a relatively rare malignancy and radical nephroureterectomy (RNU) with bladder cuff excision (BCE) is considered as the standard of care for high-risk non-metastatic disease. Loss of the renal unit secondary to RNU, especially in elderly patients, causes significant decline in overall renal function which in turn negatively impacts the overall survival (OS). Such radical surgeries can be spared in a select group of the patients with segmental ureterectomy (SU) or distal ureterectomy to salvage the ipsilateral kidney. In this article, we will review the oncological and renal function outcomes following such procedures. This review excludes endourologic procedures. Methods This is a non-systematic review of the published literature focusing on the nephron-sparing surgical alternatives for the management of UTUCs. The following texts were used for literature search: "nephron-sparing surgery", "segmental ureterectomy", "total ureterectomy", "partial nephrectomy", and "ileal ureter". We included the articles indexed in PubMed, written in English language, and published within the last 15 years. Key Content and Findings The main argument against the utilization of these procedures is the lack of high quality, level I evidence, which is due to the rarity of this disease and the rates of ipsilateral recurrences. Despite that, the evidence in support of these nephron-sparing surgical alternatives is increasing over time. Published literature including single/multi-centric studies & systematic reviews, suggests comparable oncological outcomes and significantly improved renal function preservation. Lymph node dissection (LND) at the time of nephron-sparing surgical alternatives is largely underutilized. Similarly, the role of neoadjuvant or adjuvant systemic chemotherapy following such procedures is also not established currently. Conclusions With comparable oncological outcomes while preserving renal function, the nephron-sparing surgical alternatives to RNU are gaining momentum. These options can be offered to patients with low volume, localized UTUC with imperative indication for renal preservation such as solitary kidney, compromised baseline, and expected significant decline in post-RNU renal function without compromising oncological principles during surgery.
Collapse
Affiliation(s)
- Sumit Saini
- Department of Urology, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Ashok Kumar Hemal
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| |
Collapse
|
4
|
Seetharam Bhat KR, Moschovas MC, Patel VR, Ko YH. The robot-assisted ureteral reconstruction in adult: A narrative review on the surgical techniques and contemporary outcomes. Asian J Urol 2020; 8:38-49. [PMID: 33569271 PMCID: PMC7859418 DOI: 10.1016/j.ajur.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the rapid increase in the use of robotic surgery in urology, the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches. This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones, and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems. However, with the potential benefits of minimal invasiveness, several pioneering reports have been published on robotic surgery in urology. By reviewing the literature on this topic, we aimed to summarize the techniques, considerations, and consistent findings regarding robotic ureteral reconstruction in adults. Robotic applications for ureteral surgery have been primarily reported for pediatric urology, especially in the context of relieving a congenital obstruction in the ureteral pelvic junction. However, contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant, iatrogenic, and traumatic conditions, which generally occur in adult patients. Nevertheless, the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population; thus, qualified prospective trials are needed for wider acceptance. However, contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction, even in the absence of haptic feedback, which can be compensated by various surgical techniques and enhanced three-dimensional visualization.
Collapse
Affiliation(s)
| | - Marcio Covas Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Vipul R Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Young Hwii Ko
- Department of Urology, Yeungnam University, Daegu, Republic of Korea
| |
Collapse
|
5
|
Asghar AM, Lee RA, Yang KK, Metro M, Eun DD. Robot-assisted distal ureteral reconstruction for benign pathology: Current state. Investig Clin Urol 2019; 61:S23-S32. [PMID: 32055751 PMCID: PMC7004836 DOI: 10.4111/icu.2020.61.s1.s23] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022] Open
Abstract
Distal ureteral reconstruction for benign pathologies such as stricture disease or iatrogenic injury has posed a challenge for urologist as endoscopic procedures have poor long-term outcomes, requiring definitive open reconstruction. Over the past decade, there has been an increasing shift towards robot-assisted laparoscopy (RAL) with multiple institutions reporting their outcomes. In this article, we reviewed the current literature on RAL distal ureteral reconstruction, focusing on benign pathologies only. We present peri-operative data and outcomes on the most common technique, ureteral reimplantation, as well as adjunct procedures such as psoas hitch and Boari flap. Additionally, we present alternative techniques reported in the literature with some technical considerations. Lastly, we describe the outcomes of the comparative studies between open, laparoscopy, and RAL. Although the body of literature in this field is limited, RAL reconstruction of the distal ureter appears to be safe, feasible, and with some advantages over the traditional open approach.
Collapse
Affiliation(s)
- Aeen M Asghar
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Randall A Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Kevin K Yang
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Michael Metro
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Daniel D Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| |
Collapse
|
6
|
Mueller JJ, Leitao MM. Robotic-assisted psoas hitch with ureteral reimplantation. Int J Gynecol Cancer 2019; 29:223. [PMID: 30640709 DOI: 10.1136/ijgc-2018-000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To demonstrate a robotic-assisted psoas hitch with ureteral reimplantation. METHODS We gleaned video footage from a robotic-assisted psoas hitch procedure performed for a patient with an isolated pelvic recurrence of ovarian cancer. RESULTS We demonstrate trocar placement and a robotic-arm docking strategy for pelvic recurrence of ovarian cancer. We also show surgical steps involved in a psoas hitch and reimplantation of a transected ureter into the bladder. Special emphasis is placed on guiding the surgeon using key robotic instruments and materials to optimize the robotic completion of this procedure. Key components of the procedure, including en bloc tumor excision and ureteral transection, are shown. The bladder is placed on traction using the fourth arm, and the avascular planes of dissection, including the space of Retzius and the paravesical spaces, are shown. The bladder is then backfilled to allow the surgeon to determine the ideal placement of the ureteral reimplantation to ensure the anastomosis is tension free. The surgeon then demonstrates where and how to place anchoring sutures from the bladder to the psoas muscle. The ureter is examined to determine where it can be implanted in the bladder with zero tension or angulation, which would compromise function and healing. The ureter is prepared for reimplantation, including trimming, tagging, and spatulation. An instrument tie technique is used to implant the ureter into the bladder and a ureteral stent is placed. Robotic-assisted psoas hitch with ureteral reimplantation has been described in the literature.1-4 CONCLUSIONS: Through the use of still photographs and video, we demonstrate the technique of robotic-assisted psoas hitch with ureteral reimplantation.
Collapse
Affiliation(s)
- Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA .,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, New York, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.,Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, New York, USA
| |
Collapse
|