A Multi-Institutional Experience with Robotic Vesicovaginal and Ureterovaginal Fistula Repair After Iatrogenic Injury

Robotic-assisted vs. open ureteral reimplantation: a multicentre comparison

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.

Surgical and Quality of Life Outcomes Following Robotic-Assisted (da Vinci) Laparoscopic Repair of Vesicovaginal Fistula: A Case Report and Video Demonstration

This report presents the case of a 63-year-old woman who developed a vesicovaginal fistula as a complication of a previous total hysterectomy. The fistula was treated with the use of the da Vinci X surgical system by a multi-disciplinary operating team, including senior Robotic Urological and Gynecological Surgeons at St. Luke's Hospital in Thessaloniki, Greece. The patient was monitored up to 12 months post-op at the time of writing and she was asked to evaluate post-op quality of life using the SF-36 and ICIQ-SF-UI questionnaires. The robotic surgical procedure was completed successfully. The total operation duration was 105 minutes, without any intra-operative complications. The patient was hospitalized for two days and made a swift, uneventful recovery. Regarding the quality of life, the patient reported satisfactory improvement in almost every domain assessed compared to her pre-op assessment; an improvement that was maintained throughout the reported follow-up period. At the time of writing, the patient reports no long-term complications and satisfactory urinary continence. Robotic-assisted laparoscopic vesicovaginal fistula repair is an effective and safe treatment option for this rare complication, as indicated by both post-operative data and the patient's own self-evaluation in this report. Further research is warranted, focusing on refining the surgical technique and comparing this to other alternative methods aiming to further improve patient outcomes.

Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology

The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were 'robotic assisted', 'ureteric reimplantation', 'cystoplasty', 'ileal conduit', 'neobladder', 'sacrocolpopexy', 'colposuspension', 'artificial urinary sphincter', 'genitourinary fistula' and 'posterior urethral stenoses'. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.

Benign Hepatic Tumors and Liver Transplantation: A Literature Review

Management of benign liver tumors represents still an open debate, with no clear guidelines for patient selection, treatment options, and indications to surgical intervention. Usually, most of these diseases are conservatively treated, in view of their low potential malignancy and incidental diagnosis. However, when the lesions are symptomatic, with a major hepatic parenchyma involvement or life-threatening complications, liver transplant represents the only curative option. The scope of this review is to present an up-to-date state of the art of transplantable benign hepatic neoplasms.

Robotic ureteral reimplantation for the management of ureterovaginal fistula: four cases at a single center

Background

To describe our initial experience with robotic ureteral reimplantation for the management of ureterovaginal fistulas.

Methods

Between January 2018 and January 2020, four patients received robotic ureteral reimplantation for ureterovaginal fistulas. All patients were diagnosed based on anterograde urography and computed tomography urography (CTU). Follow-up was performed with magnetic resonance urography and renal ultrasound as well as the clinical assessment of symptoms.

Results

The mean age of all patients was 50.3 (range, 37–65) years. The cause of the ureterovaginal fistula in four patients was due to a previous hysterectomy. The mean time from fistula diagnosis to robotic repair surgery was 14.5 (range, 3–36) months. All robotic procedures were successfully performed without intraoperative complications or open conversion. The mean operative time was 137 (range, 116–171) minutes, and the mean estimated blood loss was 25 (range, 10–50) mL. No postoperative complications that were high grade (grade III and IV) occurred within one month of surgery. Patients had the double-J (D-J) stents removed 2 months after surgery and the nephrostomy tubes removed 3 months after the operation. There was a 100% success rate without serious complications, such as the leakage of urine and side progressive hydronephrosis, during the 6 to 24 months of follow-up.

Conclusions

Our initial results and experience showed that robotic ureteral reimplantation for the management of ureterovaginal fistula is safe and feasible.