Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York City, New York, USA.
Int J Gynecol Cancer. 2019 Jan;29(1):223. doi: 10.1136/ijgc-2018-000009.
To demonstrate a robotic-assisted psoas hitch with ureteral reimplantation.
We gleaned video footage from a robotic-assisted psoas hitch procedure performed for a patient with an isolated pelvic recurrence of ovarian cancer.
We demonstrate trocar placement and a robotic-arm docking strategy for pelvic recurrence of ovarian cancer. We also show surgical steps involved in a psoas hitch and reimplantation of a transected ureter into the bladder. Special emphasis is placed on guiding the surgeon using key robotic instruments and materials to optimize the robotic completion of this procedure. Key components of the procedure, including en bloc tumor excision and ureteral transection, are shown. The bladder is placed on traction using the fourth arm, and the avascular planes of dissection, including the space of Retzius and the paravesical spaces, are shown. The bladder is then backfilled to allow the surgeon to determine the ideal placement of the ureteral reimplantation to ensure the anastomosis is tension free. The surgeon then demonstrates where and how to place anchoring sutures from the bladder to the psoas muscle. The ureter is examined to determine where it can be implanted in the bladder with zero tension or angulation, which would compromise function and healing. The ureter is prepared for reimplantation, including trimming, tagging, and spatulation. An instrument tie technique is used to implant the ureter into the bladder and a ureteral stent is placed. Robotic-assisted psoas hitch with ureteral reimplantation has been described in the literature.1-4 CONCLUSIONS: Through the use of still photographs and video, we demonstrate the technique of robotic-assisted psoas hitch with ureteral reimplantation.
展示机器人辅助腰大肌悬带术与输尿管再植入。
我们从机器人辅助腰大肌悬带术治疗卵巢癌孤立性骨盆复发患者的视频中获取了片段。
我们展示了用于卵巢癌骨盆复发的套管针放置和机器人臂对接策略。我们还展示了腰大肌悬带术和将切断的输尿管再植入膀胱的手术步骤。特别强调使用关键的机器人器械和材料指导外科医生，以优化该程序的机器人完成。展示了包括整块肿瘤切除和输尿管切断在内的程序的关键部分。使用第四臂对膀胱进行牵引，并展示了无血管解剖平面，包括Retzius 间隙和膀胱旁间隙。然后向膀胱内注水，使外科医生能够确定输尿管再植入的理想位置，以确保吻合口无张力。然后，外科医生演示了从膀胱到腰大肌放置锚固缝线的位置和方法。检查输尿管，以确定在无张力或无角度的情况下可以将其植入膀胱的位置，因为这会影响功能和愈合。对输尿管进行再植入准备，包括修剪、标记和展平。使用器械结扎技术将输尿管植入膀胱，并放置输尿管支架。机器人辅助腰大肌悬带术与输尿管再植入已在文献中描述。1-4
通过使用静态照片和视频，我们展示了机器人辅助腰大肌悬带术与输尿管再植入的技术。
