Presentation Authors: Kevin Hebert*, Jason Joseph, Matthew Gettman, Matthew Tollefson, Igor Frank, Boyd Viers, Rochester, MN
Introduction: Iatrogenic distal ureteral injuries can occur during pelvic surgery due to the close proximity of the ureter to adjacent structures and difficult visualization in the pelvis/retroperitoneum. Surgical management can include ureteroneocystostomy, psoas hitch, and boari flap repair. Over the last 20 years, minimally invasive techniques have been developed to decrease post-operative pain, hospitalization time, and post-operative morbidity. Release of the da Vinci SP surgical platform (Intuitive Surgical, Sunnyvale, CA) in September 2018, created new intra-operative challenges for minimally invasive genitourinary reconstructive surgeons. Based on our experience with the da Vinci SP platform, we sought to characterize and demonstrate single port specific techniques for a true single port robotic assisted ureteroneocytostomy.
Methods: We present a 34 year-old female with a past surgical history of an obliterative, right, distal ureteral stricture after undergoing a total abdominal hysterectomy for benign indications. After a period of ureteral rest with a nephrostomy tube, the patient elected to undergo a robotic assisted ureteroneocystostomy using the da Vinci SP platform.
Results: Operative time was 127 minutes, estimated blood loss was 20cc, and there were no complications. Incision length was a 2.5 cm and was located at the infra-umbilicus. This was successfully completed without the use of an assistant port.
Conclusions: To our knowledge, this represents the first experience of a robotic assisted ureteroneocystostomy using the da Vinci SP platform without the use of an assistant port.This approach is safe and revealed a similar operative time to other types of robotic console systems. SP specific considerations include suction device placement and needle entry without the use of an assistant port. An advantage of this technique includes improved cosmesis as well as enhanced visualization and dexterity of the fully jointed surgical instruments. Further studies are needed to assess for differences in perioperative outcomes.