Robotic versus open distal ureteral reconstruction and reimplantation for benign stricture disease

Abstract

Background and purpose: Minimally invasive techniques are currently used for numerous urologic procedures, given decreased morbidity and equivalent outcomes to open surgery. There is, however, a relative paucity of data related to robot-assisted ureteral reimplantation (RAUR) in adult patients for benign stricture disease. We sought to determine the periprocedure outcomes of open distal ureteral reimplantation vs RAUR at our institution.

Patients and methods: We retrospectively identified 10 consecutive mid/distal RAUR procedures performed by one surgeon since 2005. Twenty-four patients undergoing open mid/distal ureter reconstruction over the same period were identified, and 10 controls matched for age and body mass index (BMI) were used for comparison. Demographic, operative, and clinical/radiographic outcomes were compared.

Results: Etiology of the strictures included stone disease (n=8, 40%), iatrogenic injury during previous abdominopelvic surgery (n=10, 50%), or other causes (n=2, 10%). None of the robotic procedures necessitated conversion to open surgery. No intraoperative complications occurred. Six neocystostomies, three psoas hitches, and one Boari flap were completed in an open fashion. Four neocystostomies, four psoas hitches, and two Boari flaps were performed in the RAUR group. Estimated blood loss (30.6 vs 327.5 mL, P=0.001) and length of hospital stay (2.4 vs 5.1 d, P=0.01) were significantly reduced in the robotic group. Median BMI (29.4±5.3 vs 26.5±5.2, P=0.130) and operative time in minutes (306.6 vs 270.0 min, P=0.316) were higher in the robotic group, although these were not statistically significant. None of the patients in either group had clinical or radiologic evidence of recurrent stricture disease at a median follow-up of 30 and 24 months in the open and RAUR groups, respectively. The retrospective comparative nature of this study may introduce selection bias.

Conclusions: In experienced hands, RAUR for mid/distal benign ureteral strictures appears to be a reasonable alternative to open surgery.