Login to Access Video or Poster Abstract: MP24-02
Sources of Funding: N/A

Introduction

Ureteroneocystostomy with creation of Boari flap represents a good option to substitute for the loss of the distal ureter in both benign and malignant conditions. Traditionally the procedure is performed through a large midline or Gibson incision. Utilizing the robotic daVinci surgical sytem made it feasible to achieve the objectives of the procedure with minimally invasive approach. We aim to report on our first series of robotic assisted ureteral substitution with Boari flap.

Methods

Between September 2009 and May, 2016, the de Vinci Si robotic system was used to reconstruct 11 distal ureters for 3 benign and 8 malignant conditions, in our institute. We utilized the 5 W shaped trocar placement in 8 cases and added sixth trocar for assistance in 3 cases. The remaining ureteral end was spatulated and reimplanted end to end to the Boari flap. Utilizing the daVinci robotic sytem we implanted 6 right ureters and 5 left ureters into the robotically created Boari Flap. Negative margin was insured in all the malignant cases.

Results

The average patient age was 67 years (ranging from 34-79). We had 5 males and 6 females patients. All cases were completed robotically with no conversion, the patients were followed for an average of 32 months (ranging from 3 months to 64 months). The ureters were patent in all of the 3 (% 27) patients who had benign ureteral stricture. However, two patients (%18) who had lower ureteral TCC developed ureterovesical anastomosis stricture. . Both of the strictures were due to high grade TCC on the initial and final pathology after nephroureterectomy with excision of the flap. One patient with history of high grade TCC of the lower ureter developed multifocal high grade TCC in the renal pelvis on the same side 3 years later.

Conclusions

Robotic reconstruction of the lower ureter with Boari flap is feasible and has an acceptable oncologic outcome. High grade TCC of the lower ureter is predictor of recurrence at the anastomosis. Longer follow up is needed especially in cases of malignancy.

Funding

N/A