REVIEW   

Minerva Urologica e Nefrologica 2018 June;70(3):231-41

DOI: 10.23736/S0393-2249.18.03137-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Robotic-assisted laparoscopic repair of ureteral injury: an evidence-based review of techniques and outcomes

Andrew T. TRACEY ¹, Daniel D. EUN ², Michael D. STIFELMAN ³, Ashok K. HEMAL ⁴, Robert J. STEIN ⁵, Alexandre MOTTRIE ^{6, 7}, Jeffrey A. CADEDDU ⁸, J. Uwe STOLZENBURG ⁹, Andre K. BERGER ¹⁰, Niccolò BUFFI ¹¹, Lee C. ZHAO ¹², Ziho LEE ², Lance HAMPTON ¹, Francesco PORPIGLIA ¹³, Riccardo AUTORINO ^{1, 14} ✉

¹ Division of Urology, VCU Medical Center, Richmond, VA, USA; ² Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; ³ Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA; ⁴ Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA; ⁵ Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA; ⁶ Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; ⁷ OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; ⁸ Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA; ⁹ Department of Urology, Medical School, University of Leipzig, Leipzig, Germany; ¹⁰ USC Institute of Urology, University of Southern California, Los Angeles, CA, USA; ¹¹ Department of Urology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; ¹² Department of Urology, NYU Health System, Langone Medical Center, New York, NY, USA; ¹³ Department of Urology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy; ¹⁴ Unit of Urology, “L. Vanvitelli” University, Naples, Italy

INTRODUCTION: Iatrogenic ureteral injuries represent a common surgical problem encountered by practicing urologists. With the rapidly expanding applications of robotic-assisted laparoscopic surgery, ureteral reconstruction has been an important field of recent advancement. This collaborative review sought to provide an evidence-based analysis of the latest surgical techniques and outcomes for robotic-assisted repair of ureteral injury.
EVIDENCE ACQUISITION: A systematic review of the literature up to December 2017 using PubMed/Medline was performed to identify relevant articles. Those studies included in the systematic review were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Additionally, expert opinions were included from study authors in order to critique outcomes and elaborate on surgical techniques. A cumulative outcome analysis was conducted analyzing comparative studies on robotic versus open ureteral repair.
EVIDENCE SYNTHESIS: Thirteen case series have demonstrated the feasibility, safety, and success of robotic ureteral reconstruction. The surgical planning, timing of intervention, and various robotic reconstructive techniques need to be tailored to the specific case, depending on the location and length of the injury. Fluorescence imaging can represent a useful tool in this setting. Recently, three studies have shown the feasibility and technical success of robotic buccal mucosa grafting for ureteral repair. Soon, additional novel and experimental robotic reconstructive approaches might become available. The cumulative analysis of the three available comparative studies on robotic versus open ureteral repair showed no difference in operative time or complication rate, with a decreased blood loss and hospital length of stay favoring the robotic approach.
CONCLUSIONS: Current evidence suggests that the robotic surgical platform facilitates complex ureteral reconstruction in a minimally invasive fashion. High success rates of ureteral repair using the robotic approach mirror those of open surgery, with the additional advantage of faster recovery. Novel techniques in development and surgical adjuncts show promise as the role of robotic surgery evolves.

KEY WORDS: Surgical flaps - Robotic surgical procedures - Ureter - Wounds and injuries