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Minerva Urologica e Nefrologica 2021 Jan 13

DOI: 10.23736/S0393-2249.20.04191-0


lingua: Inglese

Totally intracorporeal robotic ileal ureter replacement: focus on surgical technique and outcomes

Antonio A. GROSSO , Fabrizio DI MAIDA, Andrea MARI, Riccardo CAMPI, Alfonso CRISCI, Graziano VIGNOLINI, Lorenzo MASIERI, Marco CARINI, Andrea MINERVINI

Department of Urology, University of Florence, Careggi Hospital, Florence, Italy


BACKGROUND: Aim of the study was to describe our totally intracorporeal robotic ileal ureter replacement technique, reporting perioperative and mid-term results and compare it with previous similar experiences, specifically focusing on technical considerations.
METHODS: Three patients were submitted to robotic ileal ureter substitution for long ureteral defects in our institution during 2019. The procedures were carried out fully intracorporeally. Two patients received a complete replacement of the urinary tract using an ileal segment, while in one patient the lower ureteral stump was maintained, and an ileal-ureter anastomosis was performed distally. Patients’ baseline characteristics, as well as, perioperative and mid-term results were collected. A detailed description of the technique is reported and compared with prior similar experiences.
RESULTS: Median operative time was 270 (range 240-300) min. No Clavien-Dindo complications >2 were collected. All patients experienced a fast return to oral intake and canalization. Antegrade pyelography, performed a 1-month follow-up, revealed full passage of the medium contrast in those patients submitted to complete ileal ureter replacement while, in the third one, stenosis at the level of ileal-ureter anastomoses was found.
CONCLUSIONS: Robotic ileal ureter replacement can be performed completely intracorporeal with optimal results and limited complication rate, in selected cases. According to our considerations, specific surgical steps are needed to reduce the risks related to this procedure, including avoiding partial ileal substitution.

KEY WORDS: Challenge surgery; Ileal ureter; Long ureteral defect; Robotic reconstructive procedure

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