Single Surgeon Experience with Robot-Assisted Ureteroureterostomy for Pathologies at the Proximal, Middle, and Distal Ureter in Adults

Lee, Ziho; Llukani, Elton; Reilly, Christopher; Mydlo, Jack H.; Lee, David I.; Eun, Daniel

doi:10.1089/end.2013.0075

Cited by 32 publications

(21 citation statements)

References 19 publications

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“…When ureteroscopy reveals intrinsic endometriosis (Figure 13), (typically 3-4 cm from the UVJ) ureterectomy of the involved segment is necessary ( Figures 10-16) subject to consideration of the best surgical technique [10]. In those cases where the distal ureter stump (close to the UVJ) is greater than 1 cm, one can elect to perform an end-to-end ureteroureterostomy (Figure 17), another ureteroscopy after the anastomosis (Figure 18), with placement of a double J catheter [11,12].…”

Section: Trocar Sites Position Of Surgeons For Access To the Right Dmentioning

confidence: 99%

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New Paradigms in Endometriosis Surgery of the Distal Ureter

Júnior¹,

Vieiralves²,

Buere³

et al. 2018

Recent Advances in Laparoscopic Surgery [Working Title]

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It is estimated that 2% of endometriosis cases involve the urinary tract and that the ureter is involved in up to 30% of these cases, or 0.6% of all endometriosis cases. Increasingly, the standardization and systematization of surgical treatment of endometriosis require the surgeon to have knowledge of the surgical spaces and the ureteral and surrounding pelvic anatomy in order to carry out a cytoreductive surgery that is as possible. A thorough workup is essential for the differentiation of intrinsic or extrinsic endometriosis of the ureter. The use of the resonance imaging preoperatively and ureteroscopy intraoperatively is now considered indispensable. The decision and choice of the best technique will be guided by the diagnosis (intrinsic or extrinsic), the location of the lesions, the length of the involved segment (greater or less than 3 cm), vitality of the ureter stumps, and anastomosis without tension. The main alternatives are ureterolysis and dilatation with balloon catheter which is performed for extrinsic endometriosis more than 85% of the time and ureterectomy for intrinsic endometriosis. To perform the reconstruction, the techniques with end-to-end anastomosis with the distal ureter stump or ureterovesical reimplantation are used. Increasingly, with better knowledge of the distal ureter anatomy, easier access through laparoscopy and in contradiction to the current recommendations, we are verifying that the end-to-end anastomosis has become the preferred option or procedure of choice for ureteral reconstruction, with ureterovesical reimplantation the second option.

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Section: Trocar Sites Position Of Surgeons For Access To the Right Dmentioning

confidence: 99%

“…However, double J catheter placement dramatically reduces such complications. Another common complication is stenosis at the anastomosis site [9,11,14].…”

Section: Complicationsmentioning

confidence: 99%

New Paradigms in Endometriosis Surgery of the Distal Ureter

Júnior¹,

Vieiralves²,

Buere³

et al. 2018

Recent Advances in Laparoscopic Surgery [Working Title]

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“…Defects of 2 to 3 cm in length may be managed with UU, whereas defects of 12 to 15 cm may be better managed via TUU or ureteral reimplantation with a Boari flap [7]. Additional length (3-4 cm) can be given by mobilizing the ipsilateral kidney and performing a downward nephropexy, with securing of the posterior kidney capsule to the psoas fascia by use of several absorbable sutures [8]. Care should be taken to avoid injury to the genitofemoral nerve and the femoral nerve in the vicinity when placing the sutures [8].…”

Section: Minimally Invasive Surgical Techniquesmentioning

confidence: 99%

“…Additional length (3-4 cm) can be given by mobilizing the ipsilateral kidney and performing a downward nephropexy, with securing of the posterior kidney capsule to the psoas fascia by use of several absorbable sutures [8]. Care should be taken to avoid injury to the genitofemoral nerve and the femoral nerve in the vicinity when placing the sutures [8]. In the case of extensive ureteral strictures, renal autotransplantation or ureteral substitution using the ileum may be required [1].…”

Section: Minimally Invasive Surgical Techniquesmentioning

confidence: 99%

“…In case of difficulties in identifying the ureter, it is suggested to first identify a healthy segment of the ureter and to then trace the ureter circumferentially toward the diseased segment. Concomitant downward nephropexy may assist in achieving a tension-free anastomosis [8]. Contraindications to performing UU are long ureteral strictures, which do not allow a tension-free end-to-end anastomosis.…”

Section: Minimally Invasive Surgical Techniquesmentioning

confidence: 99%

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Laparoendoscopic Management of Midureteral Strictures

2014

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The incidence of ureteral strictures has increased worldwide owing to the widespread use of laparoscopic and endourologic procedures. Midureteral strictures can be managed by either an endoscopic approach or surgical reconstruction, including open or minimally invasive (laparoscopic/robotic) techniques. Minimally invasive surgical ureteral reconstruction is gaining in popularity in the management of midureteral strictures. However, only a few studies have been published so far regarding the safety and efficacy of laparoscopic and robotic ureteral reconstruction procedures. Nevertheless, most of the studies have reported at least equivalent outcomes with the open approach. In general, strictures more than 2 cm, injury strictures, and strictures associated either with radiation or with reduced renal function of less than 25% may be managed more appropriately by minimally invasive surgical reconstruction, although the evidence to establish these recommendations is not yet adequate. Defects of 2 to 3 cm in length may be treated with laparoscopic or robot-assisted uretero-ureterostomy, whereas defects of 12 to 15 cm may be managed either via ureteral reimplantation with a Boari flap or via transuretero-ureterostomy in case of low bladder capacity. Cases with more extended defects can be reconstructed with the incorporation of the ileum in ureteral repair.

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