To describe the use of the robotic platform for proximal suture placement during perineal urethroplasty in the posterior and proximal anterior urethra. Repair of posterior urethral and proximal bulbar strictures requires deep perineal dissection, making visualization and accurate placement of sutures challenging.
The robotic platform has demonstrated benefits in these characteristics in deep pelvic surgery.
We report a retrospective review of ten patients who underwent robotic-assisted urethroplasty at a single institution by a single surgeon in a one year period. All patients underwent a standard perineal dissection with robotic-assisted placement of proximal sutures. Post-operative outcomes include urethroplasty leak rate as determined by voiding cystourethrograms (VCUG), urethroplasty success rate, and perioperative complications.
The mean age of this cohort was 43 years old (14-68). Average stricture length was 2.2cm (1.5-3.0cm) and most frequently in the bulbar urethra (5/10). Seven patients underwent non-transecting urethroplasties while three underwent transecting anastomotic repair. At post-operative VCUG, no patient had urinary extravasation. Average set-up time for the robotic portion of the surgery was 15 minutes with 30-45 minutes needed for suture placement.
Robotic-assisted urethroplasty provides excellent visualization and ergonomics for posterior and proximal bulbar urethral reconstruction. This is particularly helpful in patients with narrow pelvic anatomy and long distances from the perineal skin to the proximal urethral edge. Operative and post-operative outcomes are comparable to the standard approach with improved surgeon comfort and visualization. Additional follow up is required to assess long term outcomes in comparison to a standard approach.
Urology. 2018 Nov 16 [Epub ahead of print]
Stephen H Unterberg, Sunil H Patel, Thomas W Fuller, Jill C Buckley
Department of Urology, University of California San Diego, San Diego, CA., Department of Urology, University of California San Diego, San Diego, CA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/30452962
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