Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Robotic distal ureterectomy with reimplantation in malignancy: technical nuances

Iqbal Singh, Karim Kader, Ashok K. Hemal

Department of Urology, Wake Forest University Medical School & Baptist Medical Centre, Winston Salem, North Carolina, USA
Address correspondence to Dr. Ashok K. Hemal, Department of Urology, Wake Forest University Medical School & Baptist Medical Centre, Medical Centre Boulevard, Winston Salem- 27157, North Carolina USA

Canadian Journal of Urology 2009, 16(3), 4671-4676.

Abstract

Aim: To present the point of technique of robotic distal ureterectomy under cystoscopic guidance with pelvic lymphadenectomy (PLND), ureteral reconstruction with and without a psoas hitch in patients with distal ureteral urothelial cancer (DUCC) and to review the current literature.
Methods: The various steps of operative technique of robotic PLND, distal ureterectomy under cystoscopic guidance, ureteral reconstruction with and without a psoas hitch in patients of DUCC are described. Several tricks have been highlighted to undertake such procedure. The published English literature was also searched using the key words; robot, laparoscopy, ureteral reimplantation, distal ureterectomy, psoas hitch, and ureteroneocystostomy; so as to provide an up-to-date review on subject.
Results: The technique robotic pelvic lymphadenectomy, distal ureterectomy, ureteral reimplantation with and without a psoas hitch in patients with DUCC was successful in both our patients. The mean operating room time, robotic (console) time, mean estimated blood loss and mean hospital stay were 250 min, 130 min, 150 cc and 2.2 days respectively. There were no complications.
Conclusions: The technique of robotic distal ureterectomy with ureteral reimplant for malignant ureteral strictures continues to be in evolution. Surgeon should be versatile with various options and technical nuances while dealing with these cases. The short-term oncologic outcomes appear to be satisfactory and encouraging, while the long-term results are awaited.

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