Introduction: Morbidity associated with traditional reconstruction of complex ureteral strictures has led to interest in applying the success of buccal graft urethroplasty to the ureter. C...

Objective
To evaluate the long-term outcomes of robotic-assisted laparoscopic (RAL) upper urinary tract (UUT) reconstruction performed at a tertiary referral centre.

Materials and Methods
Data from 250 consecutive patients undergoing RAL UUT reconstruction, including pyeloplasty with or without stone extraction, ureterolysis, uretero-ureterostomy, ureterocalicostomy, ureteropyelostomy, ureteric reimplantation and buccal mucosa graft ureteroplasty, were collected at a tertiary referral centre between March 2003 and December 2013. The primary outcomes were symptomatic and radiographic improvement of obstruction and complication rate. The mean follow-up was 17.1 months.

Results
Radiographic and symptomatic success rates ranged from 85% to 100% for each procedure, with a 98% radiographic success rate and 97% symptomatic success rate for the entire series. There were a total of 34 complications, none greater than Clavien grade 3.

Conclusion
Robotic-assisted laparoscopic UUT can be performed with few complications, with durable long-term success, and is a reasonable alternative to the open procedure in experienced robotic surgeons.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bju.13086

Robotic Buccal Mucosa Graft Ureteroplasty

Outcomes of robotic-assisted laparoscopic upper urinary tract reconstruction: 250 consecutive patients.

Initial outcomes of robotic assisted laparoscopic upper urinary tract reconstruction – report of the first 7 cases

Bowel interposition and auto-transplantation of kidney, thought to be a major undertaking, remain the traditional option for the treatment of major and complex ureteric lesions. Buccal mucosa, a well known tissue for urethral reconstruction, can be used safely for the repair of ureter. However, this has been reported poorly in the literature. Here we report a 59- year-old female who had a major ureteric injury by Dormia basket during ureteroscopic extraction of a 2.6 cm impacted stone at pelvi- ureteric junction. On exploration, a long anterior slit was found in the upper ureter measuring approximately 8 cm. It was successfully repaired by free buccal mucosal patch graft over a Double J stent. Thus, a major surgery was avoided. Intra venous urography at 6-month follow up demonstrated a patent ureter. Our experience is encouraging and merits wider application in complex ureteric lesion.

Robotic Buccal Mucosa Graft Ureteroplasty

Citations

Outcomes of robotic-assisted laparoscopic upper urinary tract reconstruction: 250 consecutive patients.

Initial outcomes of robotic assisted laparoscopic upper urinary tract reconstruction – report of the first 7 cases

References

Buccal Mucosa Ureteroplasty for the Treatment of Complex Ureteric Injury