Open, Laparoscopic, and Robotic Ureteroneocystotomy for Benign and Malignant Ureteral Lesions: A Comparison of over 100 Minimally Invasive Cases

Abstract

IntroductionLaparoscopic (Lap) and robotic assisted laparoscopic (RAL) approaches have been applied to ureteroneocystostomies (UNC) though such experience has been limited to small number of patients and limited follow-up. Herein we detail our experience with over 100 minimally invasive UNC, the largest such series to date. MethodsAll minimally invasive UNC performed at our institution between 1997 and 2013 and all open UNC performed between 2008 and 2013 were identified. Perioperative parameters of relevance were identified and recorded. Chi-squared and ANOVA with post-hoc Tukey analysis were performed for all categorical and continuous variables, respectively. ResultsA total of 130 patients met our study criteria. 105 underwent minimally invasive approach (20 RAL and 85 LAP). Mean follow-up duration was 504 days. Patients in the RAL, LAP, and open cohorts were of similar age, gender and laterality distribution, American Society of Anesthesiologists (ASA) score, BMI, history of previous abdominal surgery, history of prior treatment for the ureteral lesion, and surgical indication (Table 1). Operative time was similar across all cohorts (235-257 min, p=0.123). EBL was significantly lower in the RAL and Lap cohorts (100 and 150 ml) as compared to their open counterparts (300 ml, p=0.001) though decrease in Hct was similar across all groups. Only 4 intraoperative complications (4.7%) and 2 (2.4%) conversions to open were only identified in the LAP group, without statistical significance. No intraoperative complications or conversions were identified in the RAL or Open cohorts. Median LOS was significantly shorter in the minimally invasive cohorts compared to open (p<0.002). 90-Day readmission rates (18.8-20%), major complications (10-20%), and failure rates (5.9-16%) were highest in the open cohort though without statistical significance. ConclusionRAL or laparoscopic UNC is feasible, safe, and comparable to open technique with some perioperative benefit in EBL, LOS, and stent duration.