Robotic Repair of Post-Cystectomy Ureteroileal Anastomotic Strictures: Techniques for Success

Abstract

INTRODUCTION: Post-cystectomy ureteroileal anastomotic strictures that fail percutaneous or endourologic management require operative repair. These cases can be challenging, and few reports of robotic repairs exist in the available literature. Here we describe our stepwise approach to robotic surgical repair of ureteroileal strictures. TECHNIQUE: The da Vinci(®) Si Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in all cases. The port configuration is similar to robotic cystectomy, although the ports are placed in a more cephalad location on the abdominal wall. The same port configuration was used for both right- and left-sided procedures. Principal surgical techniques used include dissection of the colonic mesentery, careful peeling of the ureter off of the common iliac vessels, and mobilization of the ureter on either side of the sigmoid colon. RESULTS: Four patients with a mean age of 72 years underwent this procedure at our institution, including 2 with left-sided strictures and 2 with right-sided strictures. Three of the 4 patients had undergone prior abdominal surgery in addition to their cystectomy. All patients failed initial percutaneous and/or endourologic attempts to resolve their stricture. The ureteroileal strictures were successfully repaired robotically in all cases. With mean follow-up of 16 months no major complications were encountered, and all patients remain free of stricture recurrence to date. CONCLUSIONS: Robotic ureteroileal anastomotic stricture repair is feasible for both right- and left-sided cases. A similar operative approach can be used regardless of stricture side.