1 Department of Urology, University of Leipzig , Leipzig, Germany .
J Endourol. 2014 Jun;28(6):679-85. doi: 10.1089/end.2013.0775. Epub 2014 Feb 19.
Ureteral reconstructive surgery necessitates adequate exposure of the ureteral lesion and results in large abdominal incisions. Robot assistance allows the performance of complex ureteral reconstructive surgery through small incisions. The current series includes only cases of Boari flaps performed by robot assistance and attempts to describe in detail the technique, review the literature, as well as to expand the experience in the current literature.
Eight patients underwent ureteral reimplantation by Boari flap technique. The indications for the performance of the procedure included ureteral stricture from iatrogenic injury in three patients, recurrent ureteral stricture after multiple endoscopic stone management procedures in one patient, ureteral stricture from previous malignant disease in the pelvis or abdomen in three patients, and ureteral stricture due to trauma in one patient. Five cases were located in the left side and three cases in the right side. A variety of parameters were recorded in a prospective database including the time for robot docking and total operative time as well as catheterization and drainage time. The follow-up of the patients included the performance of renal ultrasonography 4 weeks, 3, 6, and 12 months after the procedure.
Mean age of the patients was 50.8 (range 39-62) years and mean body mass index was 26.2 (range 23.22-29.29) kg/m(2). Operative time ranged 115 and 240 (mean 171.9) minutes. Mean blood loss was 161.3 (50-250) mL. Conversion to open surgery did not take place in the current series. No intraoperative complications were observed. Postoperative complications included one case of prolonged anastomotic leakage.
The robot-assisted approach is efficient in the performance of ureteral reimplantation with Boari flap. Low blood loss, short catheterization time, low complication rate, and excellent reconstructive outcome are associated with the approach. Robot assistance seems to be beneficial for ureteral reconstructive surgery.
输尿管重建手术需要充分暴露输尿管病变部位，因此会导致腹部切口较大。机器人辅助技术可以通过小切口完成复杂的输尿管重建手术。本系列仅包括机器人辅助下 Boari 皮瓣手术的病例，并试图详细描述该技术，回顾文献，并在当前文献中扩展经验。
8 例患者接受了 Boari 皮瓣技术的输尿管再植术。该手术的适应证包括 3 例医源性损伤引起的输尿管狭窄、1 例多次内镜下结石处理后复发的输尿管狭窄、3 例盆腔或腹部先前恶性疾病引起的输尿管狭窄、1 例创伤引起的输尿管狭窄。左侧 5 例，右侧 3 例。在一个前瞻性数据库中记录了各种参数，包括机器人对接时间和总手术时间以及置管和引流时间。对患者的随访包括术后 4 周、3 个月、6 个月和 12 个月进行肾脏超声检查。
患者的平均年龄为 50.8 岁（范围 39-62 岁），平均体重指数为 26.2kg/m2（范围 23.22-29.29kg/m2）。手术时间为 115-240 分钟（平均 171.9 分钟）。平均失血量为 161.3 毫升（50-250 毫升）。本系列中没有转为开放手术的病例。术中无并发症发生。术后并发症包括 1 例吻合口漏延长。
机器人辅助方法在进行 Boari 皮瓣输尿管再植术中是有效的。低出血量、短置管时间、低并发症发生率和良好的重建效果与该方法相关。机器人辅助似乎有利于输尿管重建手术。
