Rich Jordan M, Tillu Neeraja, Grauer Ralph, Busby Dallin, Auer Rebecca, Breda Alberto, Buse Stephan, D'Hondt Frederiek, Falagario Ugo, Hosseini Abolfazl, Mehrazin Reza, Minervini Andrea, Mottrie Alexandre, Sfakianos John, Palou Joan, Wijburg Carl, Wiklund Peter, John Hubert
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Urology, Winterthur Kantonsspital, Winterthur, Switzerland.
J Endourol. 2023 Nov;37(11):1209-1215. doi: 10.1089/end.2023.0204.
Robot-assisted repair of benign ureteroenteric anastomotic strictures (UAS) provides an alternative to the open approach. We aimed to report short-, medium-, and long-term outcomes for robotic repair of benign UAS, and to provide a detailed video demonstration of critical operative techniques in performing this procedure robotically. Between January 2013 and September 2022, 31 patients from seven institutions who previously underwent radical cystectomy and subsequently developed UAS underwent robotic repair of UAS. Perioperative variables were prospectively collected, and postoperative outcomes were assessed. The surgery starts with a lysis of adhesions after previous surgery. Ureters are dissected, and the level of the stricture is identified. The ureter is then divided, and the stricture is resected. Finally, the ureter is spatulated and reimplanted with Nesbit technique after stenting with Double-J stents. In cases where both ureters show strictures, Wallace technique for reimplantation can be applied. After robotic or open cystectomy, 31 patients had a total of 43 UAS at a median (interquartile range) follow-up of 21 (9-43) months. Median stricture length was 2.0 (1.0-3.25) cm, operative duration was 141 (121-232) minutes, estimated blood loss was 100 (50-150) mL, and length of hospital stay was 5 (3-9) days. One (3.2%) case was converted to open and one (3.2%) intraoperative complication occurred. Seven (22.6%) patients experienced postoperative complications, including four (12.9%) Clavien-Dindo grade 3 complications. No Clavien-Dindo grade 4 or 5 complications occurred. Stricture recurrence occurred in 2 (6.5%) patients. These results demonstrate that robotic repair of UAS is feasible and effective approach with outcomes in line with prior open series. Authors have received and archived patient consent for video recording and publication in advance of video recording of procedure.
机器人辅助修复良性输尿管肠吻合口狭窄（UAS）为开放手术提供了一种替代方法。我们旨在报告机器人修复良性UAS的短期、中期和长期结果，并提供该手术关键操作技术的详细视频演示。2013年1月至2022年9月期间，来自7家机构的31例先前接受根治性膀胱切除术并随后发生UAS的患者接受了机器人辅助UAS修复术。前瞻性收集围手术期变量，并评估术后结果。手术从前次手术后的粘连松解开始。解剖输尿管，确定狭窄部位。然后切断输尿管，切除狭窄段。最后，在置入双J支架后，采用Nesbit技术将输尿管做成斜面并重新植入。如果双侧输尿管均出现狭窄，可采用Wallace技术进行再植。机器人或开放性膀胱切除术后，31例患者共有43处UAS，中位（四分位间距）随访时间为21（9 - 43）个月。中位狭窄长度为2.0（1.0 - 3.25）cm，手术时间为141（121 - 232）分钟，估计失血量为100（50 - 150）mL，住院时间为5（3 - 9）天。1例（3.2%）转为开放手术，发生1例（3.2%）术中并发症。7例（22.6%）患者出现术后并发症，包括4例（12.9%）Clavien-Dindo 3级并发症。未发生Clavien-Dindo 4级或5级并发症。2例（6.5%）患者出现狭窄复发。这些结果表明，机器人修复UAS是一种可行且有效的方法，其结果与先前的开放手术系列一致。作者已在手术视频录制之前获得并存档患者的视频录制和发布同意书。
