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Robot‐assisted surgery for benign distal ureteral strictures: step‐by‐step technique using the SP ® surgical system
Author(s) -
Kaouk Jihad H.,
Garisto Juan,
Eltemamy Mohamed,
Bertolo Riccardo
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14635
Subject(s) - medicine , surgery , cystectomy , ureter , urinary diversion , bladder cancer , anastomosis , da vinci surgical system , port (circuit theory) , bladder stone , robotic surgery , urinary system , cancer , endocrinology , electrical engineering , engineering
Objectives To describe the step‐by‐step techniques for robot‐assisted ureteric reimplantation performed using the Vinci SP ® surgical system (Intuitive Surgical, Sunnyvale, CA , USA), including different case scenarios with an educational purpose. Materials and Methods Three consecutive patients diagnosed with distal benign ureteric strictures were counselled for ureteric reimplantation and consented to undergo surgery performed using the da Vinci SP surgical system. Demographics and peri‐operative outcomes were collected after institutional review board approval ( IRB 13‐780). Patients provided informed consent having received an explanation for the adoption of the novel platform. The first patient was a woman referred to our institution for a left distal ureteric stricture after total hysterectomy for uterine fibroids with ureteric injury. The second patient was a man with BPH and recurrent UTIs, who was diagnosed with a 1.5‐cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero‐enteric anastomoses stricture status after radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer. Results The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed for the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port wound was used to accommodate the drainage. The bilateral ureteric reimplantation, however, was completed according to a pure single‐site approach (no extra ports were placed out of the GelSeal cap). The mean operating times were 165, 150 and 180 min, respectively. Blood loss was 50 mL in all cases. No intra‐operative complications occurred. Patients were discharged on postoperative days 1, 1 and 2, respectively, with normal serum creatinine levels. Neither transfusions nor major complications occurred. Conclusion Robot‐assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system.