Department of Urology, AIIMS, New Delhi, India.
J Endourol. 2009 Dec;23(12):2041-6. doi: 10.1089/end.2009.0103.
To describe the technique, feasibility, and effectiveness of robotic ureteric tapering (intra- or extracorporeal) and ureteroneocystostomy with and without ureteric stones retrieval in patients with symptomatic primary obstructive megaureter.
Seven patients (one bilateral) (mean age: 28.3 years) with symptomatic or complicated congenital primary obstructive megaureter were considered for robot-assisted laparoscopic reconstruction. All surgical steps were performed purely robotically via transperitoneal access by single surgeon including ureteric reimplantation and retrieval of ureteral stones, except in two patients where ureteral tapering was done extracorporeally. The relevant perioperative details, complications, and functional outcomes were analyzed. Besides clinical follow-up, objective evaluation was done with diuretic renogram and intravenous urography.
Total mean operative time and surgeon's console time were 142.5 and 127.5 minutes (range: 115-230 and 100-210), respectively, with an estimated blood loss of less than 50 mL. Mean analgesic requirement was 175 mg of diclofenac sodium and oral feeds were started after 12 hours (range: 7-16). Average hospital stay was 3.2 days (range: 2-6). Complications included one case of perioperative urinary tract infection. Average follow-up period was 16 months (range: 11-20). Follow-up ultrasonography and intravenous urography confirmed reduction of hydronephrosis and good drainage. The mean split renal function of the salvaged kidney was 41.2% at last follow-up when compared with preop average value of 41.3%.
Robotic repair and removal of ureteric stones in primary symptomatic obstructive megaureter is safe, feasible, and effective with either intracorporeal or extracorporeal ureteric tapering. It has minimal perioperative morbidity and durable success as demonstrated with subjective and objective evaluation.
描述机器人输尿管缩窄（腔内或腔外）和输尿管再植术以及伴有和不伴有输尿管结石取出术治疗症状性原发性梗阻性巨输尿管的技术、可行性和有效性。
7 名（1 例双侧）（平均年龄：28.3 岁）患有症状性或复杂性先天性原发性梗阻性巨输尿管的患者被认为适合机器人辅助腹腔镜重建。所有手术步骤均由同一位外科医生通过经腹腔入路完全机器人操作完成，包括输尿管再植术和输尿管结石取出术，仅在 2 例患者中进行了体外输尿管缩窄。分析了相关围手术期细节、并发症和功能结果。除了临床随访外，还通过利尿肾图和静脉尿路造影进行了客观评估。
总平均手术时间和外科医生控制台时间分别为 142.5 和 127.5 分钟（范围：115-230 和 100-210），估计出血量少于 50 毫升。平均需要 175 毫克双氯芬酸钠的镇痛药物，口服喂养在 12 小时后开始（范围：7-16）。平均住院时间为 3.2 天（范围：2-6）。并发症包括 1 例围手术期尿路感染。平均随访期为 16 个月（范围：11-20）。随访超声和静脉尿路造影证实积水减少和引流良好。最后一次随访时， salvaged 肾脏的平均分肾功能为 41.2%，而术前平均值为 41.3%。
机器人治疗症状性原发性梗阻性巨输尿管的修复和输尿管结石取出术是安全、可行和有效的，无论是腔内还是腔外输尿管缩窄。它具有最小的围手术期发病率和持久的成功，如主观和客观评估所示。
