Abdul-Muhsin Haidar M, McAdams Sean B, Nuñez Rafael N, Katariya Nitin N, Castle Erik P
Department of Urology, Mayo Clinic Arizona, Phoenix, AZ.
Department of Urology, Mayo Clinic Arizona, Phoenix, AZ.
Urology. 2017 Jul;105:197-201. doi: 10.1016/j.urology.2017.04.005. Epub 2017 Apr 11.
To assess the feasibility of robot-assisted transplanted ureteral reimplantation as a minimally invasive alternative to open surgery.
Between August 2015 and March 2016, 5 patients presented with transplanted ureteral strictures after failure of a previous endoscopic management. All patients underwent robot-assisted ureteral reimplantation. Patients' demographics, perioperative outcomes, and complications are reported.
All patients presented with deterioration of kidney function with or without recurrent urinary tract infection. Two patients had short strictures (<1 cm) and 2 had long strictures (>1 cm), whereas 1 patient had a nitinol ureteral stent in situ. The location of the stricture varied among these patients with 3 distal and 1 proximal. Intraoperatively, 3 patients had a modified Lich-Gregoir reimplantation and 2 patients had a pyelovesicostomy. The mean operative time was 164 (±52) minutes. There were no intraoperative complications, conversion to open surgery, or significant blood loss necessitating blood transfusion. There were no urine leaks in the immediate or late postoperative period. One patient developed a Clavien grade IVa complication (sepsis). The median length of stay, the duration of catheterization, and the duration of stenting were 1 day (range 1-5 days), 7 days (range 6-14 days), and 39 days (range 25-51 days), respectively. After a median follow-up of 79 days (range 40-139 days), no strictures or delayed leakages were identified.
Robot-assisted transplanted ureteral reimplantation is technically feasible. With a larger number of cases and a longer follow-up, robot-assisted transplanted ureteral reimplantation may provide a new and effective, minimally invasive alternative for the treatment of this complex surgical problem.
评估机器人辅助移植输尿管再植术作为开放性手术的微创替代方案的可行性。
2015年8月至2016年3月期间，5例患者在先前的内镜治疗失败后出现移植输尿管狭窄。所有患者均接受了机器人辅助输尿管再植术。报告了患者的人口统计学资料、围手术期结果及并发症。
所有患者均出现肾功能恶化，伴或不伴有复发性尿路感染。2例患者有短段狭窄（<1厘米），2例有长段狭窄（>1厘米），而1例患者原位有镍钛诺输尿管支架。这些患者狭窄的位置各不相同，3例位于远端，1例位于近端。术中，3例患者接受了改良的利奇-格雷戈尔再植术，2例患者接受了肾盂膀胱吻合术。平均手术时间为164（±52）分钟。术中无并发症、未转为开放手术，也无导致输血的大量失血。术后即刻或晚期均无尿漏。1例患者发生了Clavien 4a级并发症（脓毒症）。中位住院时间、导尿持续时间和支架置入持续时间分别为1天（范围1 - 5天）、7天（范围6 - 14天）和39天（范围25 - 51天）。中位随访79天（范围40 - 139天）后，未发现狭窄或延迟渗漏。
机器人辅助移植输尿管再植术在技术上是可行的。随着病例数量的增加和随访时间的延长，机器人辅助移植输尿管再植术可能为治疗这一复杂手术问题提供一种新的、有效的微创替代方案。
