title: Robotic ureteral reconstruction distal to the ureteropelvic junction: a large single institution clinical series with short-term follow up.
abstract: OBJECTIVE
  Use of the robotic platform for urinary reconstructive surgery is growing in popularity since its initial application with pyeloplasty for ureteropelvic junction (UPJ) repair. Although clinical series of adult robotic ureteral reconstruction appear in the literature, these reports tend to be limited in size and scope. We present the largest series to date of patients undergoing surgery for any obstruction distal to the UPJ along with outcomes and short-term follow up.
  
  
  METHODS
  A retrospective chart review was performed for patients undergoing robotic ureteral reconstructive procedures for any indication at our institution. Patients undergoing pyeloplasty, planned open procedures, and pediatric patients were excluded from the current analysis. Patient demographic data, etiology, procedure performed, and perioperative outcomes were reviewed. Postoperative follow up, imaging, and any re-interventions were also captured. The procedures performed included ureteroneocystostomy, psoas hitch, Boari flap, ureteroureterostomy, ureterolysis, ureterolithotomy, and nephropexy.
  
  
  RESULTS
  A total of 55 patients underwent robotic ureteral reconstructive procedures distal to the UPJ. Of these patients, 45 underwent intervention for a benign etiology and 10 for upper tract malignancy. All cases were successfully completed robotically with no open conversions and no intraoperative complications. Concurrent endoscopy was performed in 31 patients. The median operating room time was 221 minutes overall. Median blood loss was 50 ml with no intraoperative transfusions. The average hospital stay was 1.6 days, with 39 patients (71%) discharged on postoperative day 1. All surgical margins were negative for malignancy. The median follow up with imaging was 181 days. There were two serious complications (3.6%) and three failures (5.3%).
  
  
  CONCLUSIONS
  Robotic reconstruction of the ureter distal to the UPJ is feasible, safe, effective, and able to replicate techniques of open surgery with equivalent outcomes to large robotic pyeloplasty and smaller distal ureteral reconstruction series.
authors.affiliation: Department of Urology, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Fifer
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Raynor
authors.forename: Patrick
authors.initials: P
authors.lastname: Selph
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.forename: Davis P
authors.initials: DP
authors.lastname: Viprakasit
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.forename: Angela M
authors.initials: AM
authors.lastname: Smith
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries / Q000601:surgery*; D014515:Ureteral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures