Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series

Abstract

Background Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures. Methods From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination. Results All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12–30) cm. The median operative time was 248 (170–450) min, the median estimated blood loss was 50 (10–200) ml, and the median postoperative hospital stay was 7 (5–27) days. At a median follow-up of 16 (13–28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb). Conclusions Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.

Laparoscopic continent cutaneous urinary diversion using a modified Yang–Monti technique in an adult: A case report including 5-year follow-up

“…In addition, this procedure was economical for this patient, with a shorter operative duration and fewer high-value medical consumables. [ 13 ]…”

“…In addition, this procedure was economical for this patient, with a shorter operative duration and fewer high-value medical consumables. [13] Based on our initial experience, we offer some technical considerations for our modified Yang-Monti channel. First, retubularization of the distal ileal segment was performed longitudinally instead of transversely.…”

Advancements in minimally invasive bilateral ileal ureter replacement: a promising approach for complex long-segment ureteric strictures

“…There are different approaches to the implementation of this technique, including end-to-side anastomosis of whole ileum, demucosalised ileum, tapering, Yang-Monti and anti-refluxing techniques such as nipple valve, tunnelling, iso-peristalsis or 7 configuration. These techniques can be achieved through open, laparoscopic or robotic modalities ( 5 , 6 ). Surgical techniques that manipulate the intestinal graft further can lead to increased stricture and stenosis rate ( 5 ).…”

“…The robotic-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is another variation of this technique that has been used with success ( 6 ). The benefit of the robotic approach is the technical abilities gained that are unavailable with the laparoscopic modality.…”

“…A watertight bowel re-anastomosis is more easily achieved and reduces the risk of post-operative anastomotic leak. It reduces intra-peritoneal faecal contamination reducing post-operative infection and the ability for anti-septic lavage of ileum to reduce post-operative urinary tract infection ( 6 ). Additionally, the extracorporeal approach can serve as a bridge to reduce the learning curve before transitions to total intracorporeal ileal replacement.…”