Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland OH.
Urology. 2022 Aug;166:1-5. doi: 10.1016/j.urology.2022.04.018. Epub 2022 May 2.
To describe a novel single-port, endorobotic technique for harvesting rectal mucosa grafts (RMGs) for urethral reconstruction.
A 57-year-old man with prior transurethral procedures developed recurrent obstructive voiding symptoms. Urethrography revealed a panurethral stricture, meatus to the bulbomembranous junction. It was decided to proceed with surgical repair. Owing to the stricture's length, available oral mucosa would require additional material, and repair with a single rectal mucosa graft was offered instead. Single-port (SP) endorobotic approach offered ideal access for transanal harvest. With the patient placed in a modified lithotomy position, a GELPOINT Path transanal access platform was inserted through the anal canal. Pneumorectum was established at 12 mmHg with an AirSeal CO insufflator. A Da Vinci SP surgical system was docked, equipped with Maryland bipolar forceps and a monopolar spatula. After injection of ORISE gel, endorobotic submucosal dissection began posteriorly proximal to the dentate line.
Proceeding cranially through the rectal submucosa, a 21 ✕ 3 cm strip of mucosa was obtained with appropriate hemostasis. The resulting graft was thoroughly thinned. The robot was undocked, and the patient repositioned to high lithotomy. The patient underwent a penis-inverting, dorsolateral approach augmentation urethroplasty. With an indwelling catheter placed, the patient was discharged on postoperative day 2 with no postoperative complications.
Transanal rectal mucosal dissection with a single-port endorobotic approach can be an enticing and minimally invasive harvesting technique to provide substitution grafts for long-segment urethral reconstruction.
描述一种用于采集直肠黏膜移植物（RMG）进行尿道重建的新型单端口、内镜机器人技术。
一名 57 岁男性因先前的经尿道手术出现复发性梗阻性排尿症状。尿道造影显示全尿道狭窄，从尿道口至球膜部交界处。决定进行手术修复。由于狭窄的长度，可利用的口腔黏膜需要额外的材料，因此提供了使用单个直肠黏膜移植物进行修复。单端口（SP）内镜机器人方法为经肛门采集提供了理想的通道。患者采用改良截石位，通过肛门插入 GELPOINTPath 经肛门接入平台。使用 AirSeal CO 注气机在 12mmHg 下建立气直肠。对接达芬奇 SP 手术系统，配备马里兰双极镊子和单极刮刀。在 ORISE 凝胶注射后，内镜机器人开始在齿状线近端进行直肠黏膜下的后向前分离。
在直肠黏膜下层向头侧推进，获得了 21✕3cm 大小的带有适当止血效果的黏膜条。所得移植物被彻底变薄。机器人脱机，患者重新调整为高截石位。患者行阴茎反转、背外侧入路尿道成形术。留置导尿管后，患者在术后第 2 天出院，无术后并发症。
经肛门直肠黏膜切开术结合单端口内镜机器人技术，可能是一种有吸引力的微创采集技术，可为长段尿道重建提供替代移植物。
