Perioperative and Functional Outcomes of Robot-assisted Ureteroenteric Reimplantation: A Multicenter Study of Seven Referral Institutions.

Authors

• Albert Carrion
• Ahmed Aly Hussein
• Daniel Eun
• Abolfazl Hosseini
• Josep Maria Gaya
• Ronney Abaza
• Xavier Bonet
• Umar Iqbal
• Randall A Lee
• Ziho Lee
• Matthew Lee
• Carles Raventos
• Oriol Moreno
• Joan Palou
• Alberto Breda
• Fernando Lozano
• Francesc Vigués
• Enrique Trilla
• Khurshid A Guru

Publication/Presentation Date

1-1-2022

Abstract

BACKGROUND: Open revision of ureteroenteric strictures (UESs) is associated with considerable morbidity. There is a lack of data evaluating the feasibility of robotic revisions.

OBJECTIVE: To analyze the perioperative and functional outcomes of robot-assisted ureteroenteric reimplantation (RUER) for the management of UESs after radical cystectomy (RC).

DESIGN SETTING AND PARTICIPANTS: A retrospective multicenter study of 61 patients, who underwent 63 RUERs at seven high-volume institutions between 2009 and 2020 for benign UESs after RC, was conducted.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Data were reviewed for demographics, stricture characteristics, and perioperative outcomes. Variables associated with being stricture free after an RUER were evaluated using a multivariate Cox regression analysis.

RESULTS AND LIMITATIONS: Among 63 RUERs, 22 were right sided (35%), 34 left sided (54%), and seven bilateral (11%). Twenty-seven (44%) had prior abdominal/pelvic surgery and five (8%) radiotherapy (RT). Thirty-two patients had American Society of Anesthesiologists (ASA) scores I-II (52%) and 29 ASA III (48%). Forty-two (68%) RUERs were in ileal conduits, 18 (29%) in neobladders, and two (3%) in Indiana pouch. The median time to diagnosis of a UES from cystectomy was 5 (3-11) mo. Of the UESs, 28 (44%) failed an endourological attempt (balloon dilatation/endoureterotomy). The median RUER operative time was 195 (175-269) min. No intraoperative complications or conversions to open approach were reported. Twenty-three (37%) patients had postoperative complications (20 [32%] were minor and three [5%] major). The median length of hospital stay was 3 (1-6) d and readmissions were 5%. After a median follow-up of 19 (8-43) mo, 84% of cases were stricture free. Lack of prior RT was the only variable associated with better stricture-free survival after RUER (hazard ratio 6.8, 95% confidence interval 1.10-42.00,

CONCLUSIONS: RUER is a feasible procedure for the management of UESs. Prospective and larger studies are warranted to prove the safety and efficacy of this technique.

PATIENT SUMMARY: In this study, we investigate the feasibility of a novel minimally invasive technique for the management of ureteroenteric strictures. We conclude that robotic reimplantation is a feasible and effective procedure.

Volume

35

First Page

47

Last Page

53

ISSN

2666-1683

Published In/Presented At

Carrion, A., Hussein, A. A., Eun, D., Hosseini, A., Gaya, J. M., Abaza, R., Bonet, X., Iqbal, U., Lee, R. A., Lee, Z., Lee, M., Raventos, C., Moreno, O., Palou, J., Breda, A., Lozano, F., Vigués, F., Trilla, E., & Guru, K. A. (2022). Perioperative and Functional Outcomes of Robot-assisted Ureteroenteric Reimplantation: A Multicenter Study of Seven Referral Institutions. European urology open science, 35, 47–53. https://doi.org/10.1016/j.euros.2021.11.005

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

35024631

Department(s)

Administration and Leadership

Document Type

Article