Mediathek

Abstract

G. Frölicher¹, C. Schregel¹, Y. Trachsel¹, M. Tutal¹, H. John^1
1Kantonsspital Winterthur, Klinik für Urologie, Winterthur, Schweiz

Introduction: This video presents the surgical technique of robot-assisted ureteral re-implantation for distal ureteral fibrosis after open cystectomy and reconstruction with Studer orthotopic neobladder. A 59-year-old patient underwent open radical cystectomy and orthotopic urinary diversion for muscle-invasive bladder cancer. Postoperatively, left hydronephrosis and pyelonephritis occurred.

Materials & methods: The ports were placed in analogy to robot-assisted cystectomy. The intestinal loops were dissected guided by concomitant cystoscopy which revealed the borders between intestine and bladder wall. Right ureter was identified in the proximity of the afferent loop of the Studer neobladder and intubated with a Ch.8 mono-J catheter. The left ureter was localised using Methylene blue applied antegrade by the nephrostomy tube. Several attempts to intubate the left ureter Ch.8 mono-J were frustrane due to the long stricture. Further dissection into the retroperitoneal space was necessary. The ureter seemed totally fibrotic over several centimetres. Finally antegrade left ureteral catheterization and retrograde insertion of a Ch.8 mono-J catheter was successful. The ureters were re-implanted end-to-side with 4-0 Stratafix® running sutures.

Results: The patient was discharged on the 7th postoperative day after testing the uretero-neobladder anastomosis through a pouchography and a retrograde ureteropyelography and after removal of both mono-J stents. No perioperative complications were observed.

Conclusion: This robotic reconstructive ureteral re-implantation so far shows the feasibility and the clinical value of robotic minimal invasive approaches in complex reconstructive surgeries after open urinary diversion.