Robot-Assisted Repair of Ureteroenteric Strictures After Cystectomy with Urinary Diversion: Technique Description and Outcomes from the European Robotic Urology Section Scientific Working Group

Jordan M. Rich, Neeraja Tillu, Ralph Grauer, Dallin Busby, Rebecca Auer, Alberto Breda, Stephan Buse, Frederiek D’Hondt, Ugo Falagario, Abolfazl Hosseini, Reza Mehrazin, Andrea Minervini, Alexandre Mottrie, John Sfakianos, Joan Palou, Carl Wijburg, Peter Wiklund, Hubert John

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Robot-assisted repair of benign ureteroenteric anastomotic strictures (UAS) provides an alternative to the open approach. We aimed to report short-, medium-, and long-term outcomes for robotic repair of benign UAS, and to provide a detailed video demonstration of critical operative techniques in performing this procedure robotically. Materials and Methods: Between January 2013 and September 2022, 31 patients from seven institutions who previously underwent radical cystectomy and subsequently developed UAS underwent robotic repair of UAS. Perioperative variables were prospectively collected, and postoperative outcomes were assessed. The surgery starts with a lysis of adhesions after previous surgery. Ureters are dissected, and the level of the stricture is identified. The ureter is then divided, and the stricture is resected. Finally, the ureter is spatulated and reimplanted with Nesbit technique after stenting with Double-J stents. In cases where both ureters show strictures, Wallace technique for reimplantation can be applied. Results: After robotic or open cystectomy, 31 patients had a total of 43 UAS at a median (interquartile range) follow-up of 21 (9–43) months. Median stricture length was 2.0 (1.0–3.25) cm, operative duration was 141 (121–232) minutes, estimated blood loss was 100 (50–150) mL, and length of hospital stay was 5 (3–9) days. One (3.2%) case was converted to open and one (3.2%) intraoperative complication occurred. Seven (22.6%) patients experienced postoperative complications, including four (12.9%) Clavien–Dindo grade 3 complications. No Clavien–Dindo grade 4 or 5 complications occurred. Stricture recurrence occurred in 2 (6.5%) patients. Conclusions: These results demonstrate that robotic repair of UAS is feasible and effective approach with outcomes in line with prior open series. Patient Consent Statement: Authors have received and archived patient consent for video recording and publication in advance of video recording of procedure.

Original languageEnglish
Pages (from-to)1209-1215
Number of pages7
JournalJournal of Endourology
Volume37
Issue number11
DOIs
StatePublished - 1 Nov 2023

Keywords

  • ICG
  • anastomotic stricture
  • bladder cancer
  • radical cystectomy
  • robotic surgery
  • ureteroenteric stricture

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