title: Robotic ileal ureter: a completely intracorporeal technique.
abstract: BACKGROUND
  The first laparoscopic case of ileal interposition was reported in 2000, proving the feasibility of the procedure in a minimally invasive fashion by duplicating the principles of open surgery. Robotic applications in urology are expanding worldwide, given the unique features of the robotic platform, which facilitates more advanced laparoscopic procedures. In this study, we report a case of completely intracorporeal robotic ileal ureter and thoroughly describe our technique for this complex minimally invasive procedure.
  
  
  METHODS
  A 50-year-old gentleman with a history of right renal stones underwent multiple right ureteroscopies and thereafter developed 2 proximal ureteral strictures of 5 mm. Preoperative estimated glomerular filtration rate was 71 mL/min/1.73 m(2). Renal scan showed preserved function. The treatment options were discussed, and the patient elected to undergo a robotic ileal ureter interposition. Total operative time was 7 hours, the estimated blood loss was approximately 50 mL, and the patient progressed to regular diet on postoperative day 4 without any problem, being discharged without complications. On the postoperative day 12, a cystogram demonstrated no extravasation, and the Foley catheter was removed. After 1 month, renal scan showed the left kidney with 60.1% and the right kidney with 39.9% of total renal function. At 2 years follow-up, his serum creatinine was 1.14 and estimated glomerular filtration rate was 70 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Robot-assisted laparaoscopic ileal ureter with a completely intracorporeal technique is feasible and appears to be safe. A larger number of procedures using this technique and longer follow-up are needed to further define its role in the treatment of ureteral strictures.
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH. Electronic address: brandal@ccf.org.
authors: Luis Felipe
authors: LF
authors: Brandao
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Riccardo
authors: R
authors: Autorino
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Homayoun
authors: H
authors: Zargar
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Humberto
authors: H
authors: Laydner
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Jayram
authors: J
authors: Krishnan
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Dinesh
authors: D
authors: Samarasekera
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Georges-Pascal
authors: GP
authors: Haber
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Jihad H
authors: JH
authors: Kaouk
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Sricharan
authors: S
authors: Chalikonda
authors: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors: Robert J
authors: RJ
authors: Stein
mesh_terms: D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000601:surgery; D005919:Glomerular Filtration Rate; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000150:complications / Q000601:surgery; D011184:Postoperative Period; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*