Robot-Assisted Laparoscopic Distal Ureterectomy and Ureteral Reimplantation with Psoas Hitch

Abstract

For midureteral and distal-ureteral tumors not amenable to endoscopic resection, distal ureterectomy with ureteral reimplantation is a treatment option. When ureteral length is insufficient for direct reimplantation, additional length can be gained with either a psoas hitch or a Boari flap. We describe our technique for robot-assisted laparoscopic distal ureterectomy and ureteral reimplantation with psoas hitch.

Oncologic Outcomes for Complete Robot-Assisted Laparoscopic Management of Upper-Tract Transitional Cell Carcinoma

“…Some authors have recently described robot-assisted reconstructive surgery of the distal ureter for benign stricture disease; however, only one case series evaluated robot-assisted distal ureterectomy with reconstruction for distal ureteral TCC. [16][17][18][19][20][21] Analysis of our experience shows similar oncologic outcomes compared with open or laparoscopic management of upper-tract TCC. 3,4,[22][23][24] For RAL nephroureterectomy, at a mean follow-up of 15.2 months, 4 of the 11 patients experienced disease recurrence.…”

“…Although some have described robot-assisted reconstructive surgery of the distal ureter for benign stricture disease, only one case series evaluated robot-assisted distal ureterectomy with reconstruction for distal ureteral TCC. [16][17][18][19][20][21] In our series, management of the kidney as well as distal ureter with bladder cuff for nephroureterectomy was performed using only robot-assisted dissection. To the best of our knowledge, we are the first to report on the complete robotic approach for RAL nephroureterectomy.…”

Robotic Versus Open Distal Ureteral Reconstruction and Reimplantation for Benign Stricture Disease

“…In particular, three-dimensional visualization and six degrees of freedom at the instrument wrist have reduced the difficulty of intracorporeal suturing. Uberoi and associates 16 first described the robot-assisted ureteroneocystostomy with psoas hitch combined with a distal ureterectomy for mid and distal ureteral tumors in 2007. Casale and colleagues 17 published the largest series of robot-assisted extravesical reimplantation to date for 41 pediatric patients undergoing the procedure for vesicoureteral reflux.…”

Management of patients with upper urinary tract transitional cell carcinoma

“…Although the open approach has traditionally been described for distal ureteral resection, early reports of success with both the laparoscopic and robotic techniques indicate that these may be feasible options in the future. 56,57 Finally, bladder reimplantation should be at a site that is amenable for future upper-tract access as recurrence rates are not insignificant.…”