AUA 2017: Advanced Robotic Urinary Reconstruction

Boston, MA (UroToday.com) The robot is being widely used in reconstructive urology, most commonly for pyeloplasty and sacrocolpopexy, but is also being adapted to procedures such as the ileal ureter. Advantages of less blood loss, shorter length of stay and less pain. Disadvantages include cost, availability, and lack of haptic feedback. Dr Luke Wiegand recommends placing patients in flank for pathology above the iliac vessels and in lithotomy for pathology below the iliac vessels.

Dr Daniel Eun discussed his experience using intravenous ICG and firefly technology in order to identify good tissue during reconstructive procedures. He has used this to identify healthy ureteral and bladder tissue, to ensure that an omental flap is well perfused, and to confirm a viable ileal ureter after reconstruction. Additionally, ICG could be used to identify a ureter or a fistula to the urinary tract. To administer intravenously, he recommends injecting 3 cc ICG with 10 cc saline following. For intravesical or intraureteral administration, he will inject 5 cc of ICG via a catheter.

Dr Patricio Gargollo discussed complications of robotic surgery. He first focused on positioning, which can include nerve injury, compartment syndrome, and IV injuries. He recommends avoiding lithotomy if possible. He meticulously pads all pressure points. Obtaining access can also result in significant complications such as pre-peritoneal insufflation, retroperitoneal or mesenteric hematoma, and bowel or vascular injury. Other potential complications of robotic urologic reconstructive surgery include urine leak, internal hernias, and stoma incontinence. He stressed the importance of stimulation so the entire team is prepared to undock and open emergently if necessary.

Written By: Lisa Parrillo, MD, Genitourinary Reconstructive Surgery Fellow, University of Colorado

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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