Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
Beijing Jian Gong Hospital, Beijing, China.
Eur Urol. 2023 Dec;84(6):561-570. doi: 10.1016/j.eururo.2023.04.022. Epub 2023 May 22.
Few studies on totally intracorporeal robot-assisted ileal ureter replacement (RA-IUR) have been reported.
To report our technique and the outcomes of totally intracorporeal RA-IUR for unilateral or bilateral ureteral reconstruction, involving performing cystoplasty simultaneously.
DESIGN, SETTING, AND PARTICIPANTS: Fifteen patients underwent totally intracorporeal RA-IUR from April 2021 to July 2022 at a single center. The perioperative variables were prospectively collected, and the outcomes were assessed.
The surgical procedure included dissection of the proximal end of the ureteral stricture or renal pelvis, harvesting of the ileal ureter, rebuilding of intestinal continuity, upper anastomosis of the ileum to the renal pelvis or the ureteral end, and lower anastomosis of the ileum to the bladder. All operations were performed intracorporeally.
Patient demographics and perioperative results were prospectively collected and analyzed for perioperative complications and success rates. A descriptive statistical analysis was performed.
All patients successfully underwent totally intracorporeal RA-IUR without open conversion. Seven patients received unilateral RA-IUR and eight received bilateral RA-IUR. The mean (range) length of the harvested ileal segment was 28.3 (15-40) cm, the operative duration was 261.8 (183-381) min, the estimated blood loss was 64.7 (30-100) ml, and the duration of postoperative hospitalization was 10.5 (7-17) d. At a median (range) follow-up of 14 (8-22) mo, the subjective and functional success rates were 100% and 86.7%, respectively.
Our results demonstrate that totally intracorporeal unilateral or bilateral RA-IUR (even with ileocystoplasty) can be performed safely and efficiently with acceptable minor complications and a high success rate.
Our study indicates that totally intracorporeal robotic ileal ureter replacement surgery is safe and feasible for ureteral reconstruction, even with ileocystoplasty. The postoperative complications are acceptable. At a median follow-up of 14 (8-22) mo, the subjective and functional success rates were 100% and 86.7%, respectively.
关于全内腔机器人辅助回肠代输尿管术（RA-IUR）的研究较少。
报告我们在单中心进行的 15 例全内腔 RA-IUR 治疗单侧或双侧输尿管重建术的技术和结果，同时进行膀胱成形术。
设计、地点和参与者：2021 年 4 月至 2022 年 7 月，15 例患者在单中心接受全内腔 RA-IUR。前瞻性收集围手术期变量，并评估结果。
手术步骤包括输尿管狭窄或肾盂近端的解剖、回肠输尿管的采集、肠连续性的重建、回肠上段与肾盂或输尿管端吻合、回肠下段与膀胱吻合。所有操作均在体内进行。
前瞻性收集患者的人口统计学和围手术期结果，并分析围手术期并发症和成功率。进行描述性统计分析。
所有患者均成功完成全内腔 RA-IUR，无中转开放。7 例患者接受单侧 RA-IUR，8 例患者接受双侧 RA-IUR。采集的回肠段平均（范围）长度为 28.3（15-40）cm，手术时间为 261.8（183-381）min，估计出血量为 64.7（30-100）ml，术后住院时间为 10.5（7-17）d。中位（范围）随访 14（8-22）mo 时，主观和功能成功率分别为 100%和 86.7%。
我们的结果表明，全内腔单侧或双侧 RA-IUR（甚至联合回肠膀胱成形术）可以安全有效地进行，且并发症轻微，成功率高。
我们的研究表明，全内腔机器人辅助回肠代输尿管术用于输尿管重建是安全可行的，甚至可以联合回肠膀胱成形术。术后并发症可接受。中位随访 14（8-22）mo 时，主观和功能成功率分别为 100%和 86.7%。
