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Is the robotic approach feasible for repair of iatrogenic injuries of the lower ureter?

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Abstract

Objectives

To analyze the robotic approach as treatment of iatrogenic ureteral injuries.

Methods

Medical records were reviewed for patients undergoing robotic-assisted laparoscopic ureteral reimplantation at the University of Missouri from 2009 to 2014. Patient charts were analyzed for demographics, prior abdominal surgeries, circumstances of injury, outcomes, and other relevant information.

Results

Nine patients met inclusion criteria. The average age was 44.6. Patients had an average of 4.3 abdominal surgeries. Injury occurred during hysterectomy (open, laparoscopic, or vaginal) in eight patients (88.9 %), five cases were laparoscopic, two utilized robotic assistance, and one injury occurred during uterosacral vault suspension. All cases were related to gynecological procedures. On average, ureteral injury was detected 17.2 days after the initial surgery and repaired 62.3 days after initial operation. The average surgical repair time was 295.9 min (range 168–498) with an average blood loss of 77.2 mL (range 20–150). Four patients required a psoas hitch, with one receiving both a psoas hitch and a Boari flap. Postoperatively, patients had an average hospital stay of 2.7 days. One patient had ileus for greater than 3 days, and another was readmitted within 30 days for pain control and antiemetics following stent removal. One patient underwent open reimplantation 3 years after original surgery for development of ureteral stricture. At follow-up, all patients had returned to baseline renal function.

Conclusions

Robotic approach is feasible and a safe option for distal iatrogenic ureteral injuries occurring during gynecological procedures. Prior abdominal surgery or delayed repair does not preclude a robotic approach.

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Authors’ contribution

AL Franklin was involved in protocol/project development, data collection/management, data analysis, and manuscript writing/editing. N Pokala and J Cummings were involved in protocol/project development, data analysis, and manuscript writing/editing. C Jones was involved in data collection/management and data analysis. C Johans was involved in manuscript revision. K Strom was involved in protocol/project development.

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Authors and Affiliations

  1. Division of Urology, University of Missouri, One Hospital Dr, MC 301, McHaney Hall, Columbia, MO, 65212, USA

    Andrew Franklin, Naveen Pokala, Charles Jones, Carrie Johans & James Cummings

  2. North Colorado Urology, Banner Health, Greeley, CO, USA

    Kurt Strom

Authors
  1. Andrew Franklin
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  2. Naveen Pokala
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  3. Charles Jones
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  4. Carrie Johans
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  5. Kurt Strom
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  6. James Cummings
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Corresponding author

Correspondence to Naveen Pokala.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Franklin, A., Pokala, N., Jones, C. et al. Is the robotic approach feasible for repair of iatrogenic injuries of the lower ureter?. World J Urol 34, 1323–1328 (2016). https://doi.org/10.1007/s00345-016-1768-8

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  • DOI: https://doi.org/10.1007/s00345-016-1768-8

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