Login to Access Video or Poster Abstract: MP24-04
Sources of Funding: None

Introduction

As robotic surgery becomes more widely used, its applications are rapidly being expanded into areas of urology beyond oncology. The objective of this study is to review the institutional experience in robotic surgery in reconstructive urology.

Methods

Charts were retrospectively reviewed and patient demographic, surgical, and follow-up data were collected based on a single surgeon experience with robotic surgery in reconstructive urology from 2012-2016. Descriptive statistics were used to analyze this patient population.

Results

A total of 39 operations on 38 patients from a single surgeon were identified - 20 robotic pyeloplasties, 9 robotic ureteral reimplantations, 3 robotic uretero-ureterostomies, 3 robotic ileal conduits, 2 robotic ileal conduit revisions and 3 robotic vesicovaginal fistula repairs. Of the robotic pyeloplasties, 16 were dismembered while 4 were Y-V plasties. A crossing vessel was identified in 50% of cases. Indication for surgery included flank pain in 90% of patients, worsening kidney function in 20%, and infection in 10%. Median LOS was 1 day. Median follow-up was 7.5 months. All patients experienced resolution of symptoms, improvement in diuretic half time and stable or improved renal function on post-operative imaging. Of the robotic ureteral reimplants, 3 required psoas hitch and 3 required Boari flap. Median LOS was 1.5 days. Median follow-up was 8 months. All patients with adequate follow-up showed resolution of hydronephrosis, improvement in diuretic half-time and stable or improved renal function on post-operative imaging. All robotic uretero-ureterostomies were performed end to end. Indications included mid-ureteral stricture, iatrogenic mid-ureteral injury, and retrocaval ureter. Median LOS was 2 days. Median follow-up was 8 months, and all patients showed resolution of hydronephrosis, improvement in diuretic half-time and stable or improved renal function on post-operative imaging. All robotic ileal conduits and revisions were performed intracorporeally. Indications included urethrocutaneous fistula, neurogenic bladder, stricture of previous cutaneous ureterostomies after cystectomy, and anastamotic ureteral strictures. All robotic vesicovaginal fistula repairs were performed using sigmoid fat interposition, with one durable success.

Conclusions

Robotic surgery in the field of reconstructive urology is feasible and can be performed with good results. This is especially true of ureteral reconstruction, where all patients in this experience had good outcomes, with generally brief length of stay.

Funding

None