Single-Port Robot-Assisted Laparoscopic Ureteral Extravesicular Reimplantation Utilizing Posterior and Anterior Approach to Manage Reflux

Abstract

Introduction:

This video will discuss our experiences utilizing single-port robot-assisted laparoscopic bilateral ureteral extravesical reimplantation for management of vesicoureteral reflux. We compare anterior and posterior approaches for dissecting and isolating ureters.

Patient Presentation/Methods:

The patient is a 20-year-old woman with recurrent urinary tract infections and a history of pyelonephritis secondary to persistent chronic bilateral vesicoureteral reflux despite prior hyaluronic acid/dextranome injections. The patient signed a written informed consent for video and audio recording. The definition of success is as follows: symptom-free, absence of hydronephrosis on imaging, and absence of any additional surgeries to correct the stricture after primary surgery.

Results:

In this case, the operative time was 247 minutes, estimated blood loss (EBL) was 20 mL, and length of hospital stay was 1 day. No intraoperative complications were seen, and the patient tolerated the procedure well. We have performed a total of six robotic nonrefluxing ureteral reimplantation surgeries with mean operative time of 132.1 minutes (standard deviation = 26.5), median EBL of 27.5 mL (interquartile range [IQR] 20, 100), with 100% success rate and 0% complication rate (including no episodes of temporary urinary retention). The median length of hospital stay was 2 days (IQR 2, 2).

Conclusion:

Single-port robot-assisted laparoscopic ureteral extravesical reimplantation presents an effective and safe treatment option for patients with severe vesicoureteral reflux. The anterior approach, involving ureter dissection anterior to the fallopian tube and ovary, presents an easier and safer option than the posterior approach. In addition, the da Vinci SP™ surgical system, in our experience, appears to be as safe, effective, and easy to use as its multiport counterpart.

Declaration of Competing Interest: T.I. and A.C. have no known competing financial interests or personal relationships that could have appeared to influence the study reported. M.S. is a lecturer for Intuitive, on the Scientific Advisory Board for CONMED, a consultant for VTI Medical, and performs educational activities for Ethicon.

Runtime of video: 5 mins 17 secs

Patient Consent Statement:

This video publication received written informed consent for publication of the specific patient's case and was obtained from the patient. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.