ROBOT ASSISTED URETERO-ILEAL REIMPLANTATION IN PATIENTS WITH BENIGN STRICTURE FOLLOWING INTRACORPOREAL URINARY DIVERSION USING ICG
Background and Objectives:
Benign ureter enteric stricture (UES) development following robotic radical cystectomy and intracorporal urinary diversion (RRC-ICUD) is a rare but serious complication that may cause permanent loss of renal function. UES can be addressed endoscopically, by open or robotic surgical repair. The objective of this study was to assess the safety and efficacy of robotic uretero-ileal reimplantation for UES that developed after RRC-ICUD,
277 cases of RRC-ICUD performed in our institution between January 2013 and January 2018 were reviewed retrospectively. Patient that developed UES and underwent robot assisted uretero-ileal reimplantation were selected. Baseline patient characteristics and natural of UES was reviewed. Robotic reimplantation was performed using ICG injection via the PCNT. Visualization of ICG under near-infrared fluorescence allowed for precise identification of the stricture site. Complications at 90 days was assessed using clavien-dindo classification. Success was defined as the absence of recurrent obstruction by imaging and stable renal function, at last, follow up. Data are reported as median and interquartile range (IQR) and frequency for continues and dichotomous variables respectively.
Robotic UES repair was performed in 2.9% (8/277) patients that had RRC-ICUD. Median (IQR) time to stricture development was 7.5 (5-12.5) months. 2/3 of the patient presented with progressive renal deterioration while 1/3 of the patient were asymptomatic and were diagnosed by imaging. Median operative time was 266(166-280.5) min, median EBL was 37.5(25-60) and median LOS 3 (2-3.3) days. At 90-days postoperative complications rate was low with 1 case (12.5%) of UTI Clavien II. At median follow-up of 16 months, 9 uretero-ileal reimplantation were radiologically successful (100%) and without deterioration of renal function.
Robotic ureteral reimplantation for uretero-enteric strictures is a safe and highly effective procedure. ICG imaging provides an easy way to identify the site of stricture. The high success rate suggests that robotic UES repair can be the surgical therapeutic option of choice to treat UES that developed after Radical Cystectomy.
Benign ureter enteric stricture; robotic radical cystectomy; robotic uretero-ileal reimplantation.
University of Southern California - - Estados Unidos
Pedro Glusman Knijnik, Pietro Waltrick Brum, Pierre A Hueber, Hanna Landsberger, Luis Medina, Matthew Winter, Inderbir S Gill, Mihir M Desai, André K Berger