Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions

Nicolò Maria Buffi, Giovanni Lughezzani, Rodolfo Hurle, Massimo Lazzeri, Gian Luigi Taverna, Giorgio Bozzini, Riccardo Bertolo, Enrico Checcucci, F. Porpiglia, Nicola Fossati, G. Gandaglia, Alessandro Larcher, Nazareno Suardi, Francesco Montorsi, Giuliana Lista, Giorgio Guazzoni, Alexandre Mottrie

Research output: Contribution to journalArticle

Abstract

Background: Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. Objective: To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. Design, setting, and participants: This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Surgical procedure: Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Outcome measurements and statistical analysis: Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations: No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150. min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was>90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Conclusions: Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. Patient summary: In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. The results of the current study confirm the feasibility, safety, and efficacy of robotic surgery as a minimally invasive alternative to open surgery for the treatment of benign ureteral strictures.

Original languageEnglish
JournalEuropean Urology
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Robotics
Tertiary Healthcare
Ureterostomy
Pathologic Constriction
Tertiary Care Centers
Ureteral Obstruction
Intraoperative Complications
Feasibility Studies
Population Characteristics
Therapeutics
Operative Time
Retrospective Studies
Safety

Keywords

  • Outcomes
  • Reimplantation
  • Robot-assisted surgery
  • Surgical technique
  • Ureter
  • Ureteral strictures
  • Ureteral surgery

ASJC Scopus subject areas

  • Urology

Cite this

Robot-assisted Surgery for Benign Ureteral Strictures : Experience and Outcomes from Four Tertiary Care Institutions. / Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gian Luigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, F.; Fossati, Nicola; Gandaglia, G.; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre.

In: European Urology, 2016.

Research output: Contribution to journalArticle

Buffi, Nicolò Maria ; Lughezzani, Giovanni ; Hurle, Rodolfo ; Lazzeri, Massimo ; Taverna, Gian Luigi ; Bozzini, Giorgio ; Bertolo, Riccardo ; Checcucci, Enrico ; Porpiglia, F. ; Fossati, Nicola ; Gandaglia, G. ; Larcher, Alessandro ; Suardi, Nazareno ; Montorsi, Francesco ; Lista, Giuliana ; Guazzoni, Giorgio ; Mottrie, Alexandre. / Robot-assisted Surgery for Benign Ureteral Strictures : Experience and Outcomes from Four Tertiary Care Institutions. In: European Urology. 2016.
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abstract = "Background: Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. Objective: To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. Design, setting, and participants: This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Surgical procedure: Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Outcome measurements and statistical analysis: Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations: No robot-assisted UUY cases required surgical conversion, while 2.8{\%} of PYP cases were not completed robotically. The median operative time was 120 and 150. min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11{\%} (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2{\%} (n=4). At median follow-up of 24 mo, the overall success rate was>90{\%} for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Conclusions: Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. Patient summary: In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. The results of the current study confirm the feasibility, safety, and efficacy of robotic surgery as a minimally invasive alternative to open surgery for the treatment of benign ureteral strictures.",
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author = "Buffi, {Nicol{\`o} Maria} and Giovanni Lughezzani and Rodolfo Hurle and Massimo Lazzeri and Taverna, {Gian Luigi} and Giorgio Bozzini and Riccardo Bertolo and Enrico Checcucci and F. Porpiglia and Nicola Fossati and G. Gandaglia and Alessandro Larcher and Nazareno Suardi and Francesco Montorsi and Giuliana Lista and Giorgio Guazzoni and Alexandre Mottrie",
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T1 - Robot-assisted Surgery for Benign Ureteral Strictures

T2 - Experience and Outcomes from Four Tertiary Care Institutions

AU - Buffi, Nicolò Maria

AU - Lughezzani, Giovanni

AU - Hurle, Rodolfo

AU - Lazzeri, Massimo

AU - Taverna, Gian Luigi

AU - Bozzini, Giorgio

AU - Bertolo, Riccardo

AU - Checcucci, Enrico

AU - Porpiglia, F.

AU - Fossati, Nicola

AU - Gandaglia, G.

AU - Larcher, Alessandro

AU - Suardi, Nazareno

AU - Montorsi, Francesco

AU - Lista, Giuliana

AU - Guazzoni, Giorgio

AU - Mottrie, Alexandre

PY - 2016

Y1 - 2016

N2 - Background: Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. Objective: To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. Design, setting, and participants: This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Surgical procedure: Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Outcome measurements and statistical analysis: Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations: No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150. min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was>90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Conclusions: Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. Patient summary: In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. The results of the current study confirm the feasibility, safety, and efficacy of robotic surgery as a minimally invasive alternative to open surgery for the treatment of benign ureteral strictures.

AB - Background: Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. Objective: To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. Design, setting, and participants: This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Surgical procedure: Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Outcome measurements and statistical analysis: Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitations: No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150. min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was>90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Conclusions: Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. Patient summary: In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. The results of the current study confirm the feasibility, safety, and efficacy of robotic surgery as a minimally invasive alternative to open surgery for the treatment of benign ureteral strictures.

KW - Outcomes

KW - Reimplantation

KW - Robot-assisted surgery

KW - Surgical technique

KW - Ureter

KW - Ureteral strictures

KW - Ureteral surgery

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