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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2018 Mar 28

DOI: 10.23736/S0393-2249.18.03137-5


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, Jens-Uwe STOLZENBURG 9, Andre K. BERGER 10, Nicolò 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 Centre, Rozzano, Milan, Italy; 12 Department of Urology, NYU Health system, Langone Medical Center, New York, NY, USA; 13 Dept of Urology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy; 14 Urology Unit, “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: Boari flap - Robotic repair - Robotic surgery - Ureteral injury - Ureteroneocystostomy - Ureteral reimplant - Psoas hitch

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Publication History

Article first published online: March 28, 2018
Manuscript accepted: March 12, 2018
Manuscript received: January 25, 2018

Cite this article as

Tracey AT, Eun DD, Stifelman MD, Hemal AK, Stein RJ, Mottrie A, et al. Robotic-assisted laparoscopic repair of ureteral injury: an evidence-based review of techniques and outcomes. Minerva Urol Nefrol 2018 Mar 28. DOI: 10.23736/S0393-2249.18.03137-5

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