Pure Laparoscopic and Robot-Assisted Laparoscopic Reconstructive Surgery in Congenital Megaureter: A Single Institution Experience

Abstract

To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150–220) and 187 (range: 170–205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10–30) and 28.75 (range: 15–20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4–6) and 5.75 (range: 5–6) d, respectively, and the indwelling catheter time was 6.33 (range: 4–8) d and 7 (range: 7–7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7–8) d and 8 (range: 7–10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital megaureter.

Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults

“…Several studies have demonstrated the feasibility and safety of this minimally invasive procedure [6,8,9] . Very recently, a multicenter study compared the robotic and laparoscopic ureteral stenosis repair operations, and no significant differences were found in terms of the perioperative parameters between the 2 groups.…”

“…Robot-assisted reconstruction may overcome the drawbacks of laparoscopy to some extent. This approach offers better visualization, and the endo-wrist technology makes it suitable to perform intra-corporeal suturing at awkward angles [8] . Robot-assisted ureteroneocystostomy has been reported in several clinical centers [6,8,9] .…”

“…This approach offers better visualization, and the endo-wrist technology makes it suitable to perform intra-corporeal suturing at awkward angles [8] . Robot-assisted ureteroneocystostomy has been reported in several clinical centers [6,8,9] . However, robotic surgery increases the cost of surgical procedure and is not commonly available in developing countries, such as China.…”

Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes

“…According to our search, several case series of RALUR have described high success rates for managing POM in adults and children (Table 2) (39)(40)(41)(42)(43)(44)(45). In 2009, Hemal et al first reported RALUR for 7 symptomatic POMs aged 6 to 60 years (39).…”

Robotic Ureteral Reconstruction in the Pediatric Population

“…RAL dismembered extravesical ureteral reimplantation with or without tapering may be used for repair of obstructed megaureters (Figures 3A,C–H) (83, 84). The obstructed UVJ is divided, and a new ureteroneocystostomy anastomosis is created.…”