Category: Robotic Surgery: Upper Tract - Benign
Introduction & Objective : Although open ureterocalycostomy has been well documented, little has been reported on robot assisted techniques. Despite this, the robotic platform has been increasingly used to address complex ureteral strictures. In situations with suboptimal renal pelvis tissue or when a proximal defect is too great to be addressed with pyeloplasty, robotic ureterocalycostomy is a viable option to avoid more complicated reconstruction using grafts or bowel. Here, we present a case of proximal ureteral stricture addressed with our technique for robotic ureterocalycostomy.
Methods : 70 year old male with history of right sided partial nephrectomy, complicated by unrecognized ureteral injury. He underwent a robotic assisted pyeloplasty for definitive treatment of the ureteral injury, however, he developed a high grade ureteral stricture for which he subsequently required balloon dilation. Several weeks following dilation, the ureteral stricture recurred. He was evaluated in our office and booked for a robotic ureterolysis and reconstruction. He ultimately underwent a robotic assisted ureterocalycostomy.
Results : Total console time was 269 minutes with an estimated blood loss of 200 mL. Warm ischemia time was 17 minutes. No intraoperative complications. Patient was discharged with JP drain and percutaneous nephrostomy tube on post operative day two.
Conclusions : We demonstrate that robotic ureterocalycostomy with intraureteral use of ICG is a feasible option for patients with severe proximal ureteral strictures or history of failed surgical management. Intraureteral ICG can facilitate ureteral dissection in a severely fibrotic field. In able hands, robotic ureterocalycostomy can serve as an intermediary between revisional pyeloplasty and more complicated reconstructions using grafts or bowel.
Aryeh Keehn– Philadelphia, Pennsylvania
Mahesh Botejue– Philadelphia, Pennsylvania
Daniel Eun– Professor, Temple University, Philadelphia, Pennsylvania
Randall Lee– Urology Resident, Temple University Hospital, Philadelphia, Pennsylvania
Kevin Yang– Urology Resident, Temple University Hospital, Philadelphia, Pennsylvania