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Publication . Article . 2018

Robotic Ureteral Reconstruction Using Buccal Mucosa Grafts: A Multi-institutional Experience

Zhao, Lee C.; Weinberg, Aaron C.; Lee, Ziho; Ferretti, Mark J.; Koo, Harry P.; Metro, Michael J.; Eun, Daniel D.; +1 Authors
Closed Access  
Published: 01 Jan 2018
Publisher: Elsevier BV
Abstract
Abstract Background Minimally invasive treatment of long, multifocal ureteral strictures or failed pyeloplasty is challenging. Robot-assisted buccal mucosa graft ureteroplasty (RBU) is a technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. Objective To evaluate outcomes for RBU in a multi-institutional cohort of patients treated for revision ureteropelvic junction obstruction and long or multifocal ureteral stricture at three tertiary referral centers. Design, setting, and participants This retrospective study involved data for 19 patients treated with RBU at three high-volume centers between October 2013 and July 2016. Surgical procedure RBU was performed using either an onlay graft after incising the stricture or an augmented anastomotic repair in which the ureter was transected and re-anastomosed primarily on one side, and a graft was placed on the other side. Outcome measurements and statistical analysis Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations The onlay technique was used for 79%, while repair was carried out using the augmented anastomotic technique for the remaining cases. The reconstruction was reinforced with omentum in 95% of cases. The ureteral stricture location was proximal in 74% and mid in 26% of cases. A prior failed ureteral reconstruction was present in 53% of patients. The median stricture length was 4.0cm (range 2.0–8.0), operative time was 200min (range 136–397), estimated blood loss was 95ml (range 25–420), and length of stay was 2 d (range 1–15). There were no intraoperative complications. At median follow-up of 26 mo, the overall success rate was 90%. Conclusions RBU is a feasible and effective technique for managing complex proximal and mid ureteral strictures. Patient summary We studied robotic surgery for long ureteral strictures using grafts at three referral centers. Our results demonstrate that robotic buccal mucosa graft ureteroplasty is a feasible and effective technique for ureteral reconstruction.
Subjects by Vocabulary

Microsoft Academic Graph classification: Ureteral Stricture Autotransplantation medicine.medical_treatment medicine Ureter medicine.anatomical_structure Retrospective cohort study Surgery medicine.medical_specialty Reconstructive surgery Anastomosis Robotic surgery Pyeloplasty business.industry business

Medical Subject Headings: surgical procedures, operative

Subjects

Urology