Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review

doi:10.1016/j.ajur.2019.10.005

Asian Journal of Urology, 2020, 7 (1): 37-44 doi: 10.1016/j.ajur.2019.10.005

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Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review

Najib Isse Dirie,Shaogang Wang(

)

Department of Urology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

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Abstract

Objective: To present our experience and technique with robot-assisted ureteroneocystostomy (RAUN) procedure in adults. Methods: Between February 2015 and August 2018, a total of 30 (34 ureters) patients who underwent RAUN surgery under a single surgeon were retrospectively reviewed. Perioperative data such as age, sex, body mass index (BMI), American society of anesthesiologists score, estimated blood loss, surgical technique, operative time, complications, length of hospital stay, and stent removal time were recorded. During the follow-up, patients underwent renal function test, urinalysis, and renal ultrasound examination for evaluation. Success was defined as symptomatic and radiologic relieve. Lastly, a literature search was conducted to review all published articles regarding RAUN surgery in adults. Results: The patients’ mean age, BMI, EBL, operative time, and follow-up period were 45.4 years, 23.1 kg/m ², 65.6 mL, 182.9 min, and 21.3 months, respectively. The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondary to a previous radical hysterectomy. Of the 34 cases, 26 (76.5%) and 8 (23.5%) patients received primary RAUN and RAUN with psoas hitch technique, respectively. Refluxing RAUN method was performed in all cases. No intraoperative complications were found. Two patients had a radiologic and symptomatic recurrence; one was managed with a repeat surgery while the other received ureteral dilatation treatment. Conclusion: Both our study and the published literature showed that RAUN is a safe, less invasive, and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.

Key words： Outcomes Psoas hitch Robot-assisted Ureteroneocystostomy

Received: 16 January 2019 Available online: 19 October 2019

Corresponding Authors: Shaogang Wang E-mail: sgwangtjm@163.com

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Najib Isse Dirie,Shaogang Wang. Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review[J]. Asian Journal of Urology, 2020, 7(1): 37-44.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.10.005 OR http://www.ajurology.com/EN/Y2020/V7/I1/37

Robot-assisted ureteroneocystostomy (RAUN) procedure. (A) CT showing dilated upper urinary tract (arrow shows hydroureter); (B) Five ports: Two for the assistant and three for the robotic arms; (C) Primary RAUN anastomosis on a female patient; (D) Psoas hitch technique (arrows showing psoas muscle and a mobilized bladder).

Patient demographic.

Intra- and postoperative outcomes.

Author/year (ref)	Study design	Patients, n	Mean age (year)	Sex (male/female)	Surgical indication			Mean EBL (mL)	Mean operative time (min)	Intraoperative complication^b	Mean LOS (day)	Surgical type, n (%)			Mean follow-up (month)	Recurrence rate, n (%)
Author/year (ref)	Study design	Patients, n	Mean age (year)	Sex (male/female)	Stricture	Ureter tumor	Other	Mean EBL (mL)	Mean operative time (min)	Intraoperative complication^b	Mean LOS (day)	Primary reimplantation	Psoas hitch	Boari flap	Mean follow-up (month)	Recurrence rate, n (%)
De Naeyer et al., 2007 [11]	Case report	1	35	0/1	0	1	0	0	120	None	7.00	0	1	0	2	0
Patil et al., 2008 [18]	Retrospective	12	41.3	NA	10	0	2	48	208	None	4.30	0	12	0	15.5	0
Williams et al., 2009 [23]	Retrospective	7	43.9	1/6	6	0	1	109	247	None	2.00	7	0	0	18	1 (14.3)
Schimpf et al., 2009 [24]	Retrospective	10	64.7	8/2	2	6	2	82	189	3	2.40	5	3	2	18.3	0
Symons et al., 2009 [25]	Retrospective	6	39.3	3/3	4	0	2	NA	290	None	7.20	3	0	3	4	0
Eandi et ak, 2010 [26]	Retrospective	4	73.5	1/3	0	4	0	200	311	NA	4.70	0	4	0	15.2	1 (25.0)
Hemal et al., 2010 [27]	Retrospective	18	NA	NA	2	5	11	98.2	137.9	1	2.40	17	1	0	13.5	0
Yang et al., 2011 [28]	Prospective	3	47.7	1/2	1	1	1	116.7	NA	1	4.70	0	1	2	NA	0
Musch et al., 2012 [29]	Retrospective	5	62	4/5	1	2	2	300	306	None	7.00	2	2	1	6	0
Baldie et al., 2012 [30]	Retrospective	13	41.8	5/8	11	0	2	187	266.8	3	2.78	5	7	1	4.4	0
Kozzin et al., 2012 [13]	Retrospective	10	49.3	5/5	5	0	0	30.6	306.6	None	2.40	4	4	2	24	0
Isac et al., 2013 [14]	Retrospective	25	49	8/17	20	0	5	100	279	None	3.00	11	4	10	11.6	1 (4.0)
Musch et al., 2013 [20]	Retrospective	14	64.3	7/7	7	4	3	NA	276.5	None	11.30	5	5	4	10.2	1 (7.1)
Lee et al., 2013 [6]	Retrospective	10	52.9	1/9	2	2	6	102.5	211.7	None	2.80	4	6	0	28.5	2 (20.0)
Fifer et al., 2014 [15]	Retrospective	55	52	22/33	45	10	0	50	233	2	1.60	10	35	9	6	3 (5.3)
Slater et al., 2015 [31]	Retrospective	13	39.8	1/12	1	0	12	40	286	1	2.30	10	0	3	20.7	0
Wason et al., 2015 [32]	Retrospective	13	46	2/11	12	0	1	123	282	None	2.50	13	NS	NS	10	0
Stolzenburg et al., 2016 [33]	Retrospective	11	49.9	NA	11	0	0	155.5	166.8	None	NA	0	0	11	12.5	0
Buffi et al., 2017 [16]	Retrospective	21	43	NA	10	0	11	NA	166	None	8.00	21	0	0	24	1 (4.8)
Kaouk et al., 2018 [22] ^a	Prospective	3	55.3	2/1	1	0	2	43.3	165	None	1.30	1	2	0	NA	NA
Current Study	Retrospective	30	45.4	14/16	21	1	10	65.6	182.9	None	7.90	22	8	0	21.3	2 (6.2)

Summary of existing literatures regarding RAUN in adults.

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