Korets Ruslan, Hyams Elias S, Shah Ojas D, Stifelman Michael D
Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
Urology. 2007 Aug;70(2):366-9. doi: 10.1016/j.urology.2007.04.024.
Ureterocalicostomy is a well-established treatment option for patients with recurrent ureteropelvic junction obstruction or proximal ureteral stricture refractory to endoscopic management in the setting of diminutive or intrarenal pelvis or significant peripelvic fibrosis. We report a case of robotic-assisted laparoscopic ureterocalicostomy using the da Vinci robotic system in a patient with proximal ureteral stricture refractory to endoscopic management.
All techniques described to date for ureterocalicostomy have been either open or purely laparoscopic. We report a case of robotic-assisted laparoscopic ureterocalicostomy in a patient with refractory proximal ureteral stricture secondary to multiple interventions for stones. We used laparoscopy for the initial dissection and exposure and robotic techniques for lower pole amputation and ureterocaliceal anastomosis. Intraoperative nephroscopy was also performed through the lower pole calix. The patient had resolution of the obstruction at 10 weeks postoperatively with the stent out and radiographic confirmation of excretion and drainage.
Robotic-assisted laparoscopic ureterocalicostomy is a feasible alternative to open or laparoscopic techniques for treating refractory proximal ureteral stricture or ureteropelvic junction obstruction. To our knowledge, this is the first described case of robotic-assisted laparoscopic ureterocalicostomy with intraoperative nephroscopy.
对于患有复发性输尿管肾盂连接处梗阻或近端输尿管狭窄且在内镜治疗无效的情况下伴有小肾盂或肾内肾盂或严重肾盂周围纤维化的患者，输尿管肾盂造口术是一种成熟的治疗选择。我们报告了一例使用达芬奇机器人系统进行机器人辅助腹腔镜输尿管肾盂造口术的病例，该患者患有近端输尿管狭窄，内镜治疗无效。
迄今为止描述的所有输尿管肾盂造口术技术均为开放手术或单纯腹腔镜手术。我们报告了一例因多次结石干预导致难治性近端输尿管狭窄患者的机器人辅助腹腔镜输尿管肾盂造口术。我们首先使用腹腔镜进行解剖和暴露，然后使用机器人技术进行下极切除和输尿管肾盂吻合。术中还通过下极肾盏进行了肾镜检查。术后10周，患者拔除支架后梗阻解除，影像学证实有排泄和引流。
机器人辅助腹腔镜输尿管肾盂造口术是治疗难治性近端输尿管狭窄或输尿管肾盂连接处梗阻的开放手术或腹腔镜技术的可行替代方法。据我们所知，这是第一例描述的术中进行肾镜检查的机器人辅助腹腔镜输尿管肾盂造口术病例。
