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| Name | AUA2020 V03-06: Robotic Distal Ureterectomy with Uretero-enteric Reimplant |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 08-04-2020 04:00:30 |
| Video Discription | AUA2020 V03 06: Robotic Distal Ureterectomy with Uretero-enteric Reimplant For more 2020 Surgical Videos, visit: https://auau.auanet.org/node/28146 Eric Riedinger*, Kevin Reed, Wesley White, Knoxville, TN INTRODUCTION Radical cystectomy with urinary diversion is the mainstay of treatment for muscle invasive bladder cancer. Despite local oncologic control with extirpative intervention, these patients remain at risk for recurrence of urothelial cancer within the upper tracts. Recurrence rates of upper tract urothelial carcinoma after cystectomy range from 0.75% - 6.4%. Surgical intervention for recurrence can be challenging due to post-surgical changes from cystectomy. Robotic assisted laparoscopic surgery offers a minimally invasive approach to the management of this disease in select patients. METHODS Our patient is a 73-year-old male with extensive urologic surgical history for urothelial cancer including: left nephroureterectomy, radical cystoprostatectomy with ileal conduit urinary diversion and total urethrectomy. Routine screening with abdominal imaging demonstrated new onset right hydroureteronephrosis to the level of his conduit. Looposcopy with ureteroscopy and biopsy revealed high grade urothelial cancer in the distal 2 cm of the right ureter. We performed a robotic assisted right distal ureterectomy, with small cuff of conduit removed, and uretero-enteric reimplant at a new enterotomy site. Oblique, linear port placement was used with the camera cephalad to the ostomy site and the caudad port near midline. Intra-operative ureteroscopy was utilized to identify the proximal extent of the tumor. Frozen section of the proximal margin was negative. RESULTS The total operative time was four hours and 12 minutes. Hospital length of stay was three days. Estimated blood loss was 50 cc. Final pathology revealed pT2 high grade urothelial carcinoma with negative margins. Six weeks post-operatively, loopogram and retrograde pyelogram demonstrated excellent drainage of the right renal collecting system. CONCLUSIONS Robotic assisted distal ureterectomy for upper tract urothelial carcinoma is a feasible option for select patients. Patient specific anatomy must be factored into pre-operative counseling and surgical planning. SOURCE OF FUNDING: No source of funding |
| Category | Education |
| Tags | aua | american urological association | surgery | robotic surgery | urology | urologic surgery | AUAU | AUA2020 | surgical video library | AUA surgical video library | Radical cystectomy | urinary diversion | Ureterectomy | Uretero-enteric Reimplant | urothelial cancer | muscle invasive bladder cancer | MIBC | UTUC | upper tract urothelial carcinoma | cystectomy | distal ureterectomy | robotic assisted surgery | Robotic assisted laparoscopic surgery | MIS | Robotic assisted distal ureterectomy |
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