Nagata Chikako, Yanazume Shintaro, Kobayashi Yusuke, Fukuda Mika, Mizuno Mika, Togami Shinichi, Kobayashi Hiroaki
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
J Robot Surg. 2025 May 28;19(1):246. doi: 10.1007/s11701-025-02407-0.
The effectiveness of cystoscopy in reducing urinary tract complications during robotic gynecologic surgery is poorly documented. Since the introduction of robotic surgery at our institution, cystoscopy has been consistently employed as a standard practice, and its usefulness was investigated. This retrospective study evaluated the utility of routine cystoscopy in patients who underwent robotic surgery between February 2017 and April 2024. The outcome was the detection rate of bladder and ureteral complications. Indigo carmine was injected intravenously while suturing the post-hysterectomy vaginal stump. Light permeation of the bladder wall was visually assessed intra-abdominally. Any leakage of the indigo carmine into the peritoneum or outflow from the external ureteral opening were noted. Eleven of 403 patients were suspected of having urinary tract complications. Among the 11 patients, two exhibited damage to the serous and muscular layers of the bladder, while nine had no outflow from the external ureteral opening. Among these nine cases, one patient was found to have right ureteral obstruction, which was attributed to vaginal stump suturing. The sensitivity and specificity for ureteral obstruction detection were 100% and 98.0%, respectively. In the remaining eight patients, no urinary complications could be identified postoperatively. Overall, the rate of bladder injury was 4/403 (0.9%), all of which were repaired intraoperatively, including two cases found by cystoscopy. Ureteral obstruction was identified in 1/403 (0.2%), and the case was due to intraoperative cystoscopy. Postoperatively, ureteral stenosis was observed in 1/403 (0.2%), and urinary tract infection (cystitis: Grade 2 or less) was noted in 6/403 (1.5%). This technique is an effective diagnostic tool with minimal patient burden and is likely to accurately identify ureteral obstruction or bladder injury during surgery.
膀胱镜检查在减少机器人妇科手术期间尿路并发症方面的有效性鲜有文献记载。自我们机构引入机器人手术以来，膀胱镜检查一直作为标准操作被持续采用，并对其效用进行了研究。这项回顾性研究评估了2017年2月至2024年4月期间接受机器人手术患者常规膀胱镜检查的效用。结果是膀胱和输尿管并发症的检出率。在缝合子宫切除术后阴道残端时静脉注射靛胭脂。在腹腔内目视评估膀胱壁的透光情况。记录靛胭脂有无漏入腹膜或从输尿管外口流出。403例患者中有11例疑似有尿路并发症。在这11例患者中，2例表现为膀胱浆膜层和肌肉层受损，而9例输尿管外口无流出。在这9例中，1例患者被发现有右侧输尿管梗阻，这归因于阴道残端缝合。输尿管梗阻检测的敏感性和特异性分别为100%和98.0%。在其余8例患者中，术后未发现泌尿系统并发症。总体而言，膀胱损伤率为4/403（0.9%），所有损伤均在术中修复，其中2例通过膀胱镜检查发现。输尿管梗阻的发生率为1/403（0.2%），该病例是由于术中膀胱镜检查发现。术后，输尿管狭窄的发生率为1/403（0.2%），尿路感染（膀胱炎：2级及以下）的发生率为6/403（1.5%）。该技术是一种有效的诊断工具，对患者负担极小，且可能在手术期间准确识别输尿管梗阻或膀胱损伤。
