title: Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults.
abstract: OBJECTIVE
  To describe our initial experience with robot-assisted ureteroureterostomy (RUU) at the proximal, middle, and distal ureter.
  
  
  METHODS
  Twelve consecutive patients underwent RUU by a single surgeon (D.D.E.) between July 2009 and November 2012. Indications included three iatrogenic injuries, two impacted stones, two ureterovaginal fistulas, two idiopathic ureteral strictures refractory to conservative treatment, one primary transitional cell carcinoma of the ureter, one colon cancer metastasis to the ureter, and one invasive endometriosis. There were two proximal, three middle, and seven distal ureteral pathologies.
  
  
  RESULTS
  Tension-free anastomosis was achieved in all 12 patients. All patients with proximal and middle ureteral pathology received concomitant downward nephropexy (DN) as a standard part of RUU. Mean age of patients at the time of surgery was 52 years (range 30-69), mean body mass index was 30.0 kg/m(2) (range 21-38), mean operative room time was 190 minutes (range 104-354), mean estimated blood loss was 181 mL (range 50-400), and mean length of excised ureter on pathologic analysis was 2.0 cm (range 1.0-4.5). There was one intraoperative complication in which liver and gallbladder laceration occurred during trocar placement. Mean length of hospital stay was 1.4 days (range 1-5), and there were no postoperative complications. Mean follow up was 10 months (range 3-36). One patient had a ureteral stricture recurrence at 7 months postoperatively that led to renal unit loss and eventual nephrectomy.
  
  
  CONCLUSIONS
  RUU is feasible, safe, and demonstrates good outcomes for pathologies at the proximal, middle, and distal ureter. Concomitant DN during RUU may assist in achieving a tension-free anastomosis for proximal and middle ureteral repairs.
authors.affiliation: Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Ziho
authors.initials: Z
authors.lastname: Lee
authors.forename: Elton
authors.initials: E
authors.lastname: Llukani
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Reilly
authors.forename: Jack H
authors.initials: JH
authors.lastname: Mydlo
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Eun
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000000981:diagnostic imaging / Q000601:surgery*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D014519:Ureterostomy / Q000379:methods*; D014567:Urography