67th Annual Meeting Abstracts
Adult Robotic-Assisted Ureteral Reimplantation: Single Institution Evaluation
Behfar Ehdaie, *Casey Gundersen, Noah Schenkman
University of Virginia, Charlottesville, VA
Introduction:
Distal ureteral obstruction caused by ureteral tumors or strictures require reconstruction with ureteral reimplantation. Use of the daVinci robot facilitates laparoscopic reconstruction in these patients. We review our experience with robot-assisted ureteral reimplantation to treat distal ureteral obstruction.
Materials & Methods:
8 consecutive patients underwent robotic-assisted ureteral reimplantation between 8/2007-4/2009. Indications for ureteral reimplantation included ureteral stricture (n=5) and tumor (n=3). Patient characteristics, intraoperative parameters, short and long-term outcomes were retrospectively reviewed. Univariate and multivariate analysis were conducted to determine parameters related to adverse outcomes.
Results:
Mean age was 54 (30-82). Mean BMI was 32 (21-41). Mean hospital stay was 3.1 days (2-5). The mean blood loss was 175ml (50-400). Two patients required blood transfusions. The conversion to open rate was 38% (3/8). The reasons for conversion included: intra-abdominal adhesions and failure of progression. Five patients had previous abdominal surgeries and all of the patients that were converted to open had previous abdominal surgery (3/3). The mean follow-up was 208 days (4-600). No patients had positive margins or tumor recurrence. Two had long-term adverse outcomes including: pyelonephritis (n=1) and ureteral stricture (n=1). Univariate and multivariate analysis identified BMI as associated with conversion to open surgery (p=0.011). The mean BMI in patients who remained laparoscopic and patients who were converted to open surgery were 27.5 and 38.5 respectively.
Conclusions:
Robot-assisted ureteral reimplantation is safe and effective. Based on our series, patient selection especially with regard to previous abdominal surgery and BMI are important to minimize conversion to open surgery.
