Management of iatrogenic ureteral stricture: Robot-assisted repair.

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su Management of iatrogenic ureteral stricture: Robot-assisted repair.

==inizio abstract==

Ureteral injuries may occur during surgical procedures. Their incidence is low, the treatment is often challenging.
At our institution robot-assisted uretero-ureterostomy was performed in four adults with iatrogenic lumbar and iliac strictures
MATERIALS AND METHODS
From January 2010 to June 2012, four patients underwent robot-assisted uretero-ureterostomy . Two patients had iliac stricture following laparoscopic hysterectomy, one patient had pelvic ureteral stricture following robotic assisted prostatectomy, one patient had ureteral stricturedue to Schistosomiasis. Preoperative evaluation included computed tomography (CT) scan in all the patients.
RESULTS
A flank position was used for all patients with lumbar stenosis. The optical port, two 8-mm robotic ports, and one 5-mm assistant port were used. The site and the extension of the stricture were also defined using the flexible ureterorenoscope. After the stricture resection, the anastomosis was performed with two running sutures on a ureteral double-J stent.
Success was defined as no postoperative symptoms and evidence of no obstruction at the CT/urography and at the MAG3 scan at 6-mo follow-up.
Robotic-assisted repair of ureteral strictures was technically feasible in all four patients. Average operating time was 140min, and median hospital stay was 4 days. No significant complication occurred. Absence of stricture recurrence and no reduction of kidney function were confirmed by CT/urography, MAG3 scans and lab tests. At a mean follow-up of 18 months, all patients were asymptomatic.
CONCLUSIONS:
Robotic surgery is effective in the repair of iatrogenic ureteral strictures, offering tightwater suture. The flexible ureterorenoscopy is useful to define the site and the extensionof the stricture, in order to spare as much ureter as possible.

==fine abstract==