title: Robotic-Assisted Ureteral Re-implantation: A Case Series.
abstract: BACKGROUND
  Minimally invasive surgical techniques are currently used for numerous urologic disorders and generally offer decreased morbidity and equivalent outcomes compared with open surgery. There is a relative paucity of data on robot-assisted ureteral re-implantation (RAUR) in adult patients for benign stricture disease.
  
  
  METHODS
  We retrospectively reviewed our recent experience with mid-/distal ureteral reconstruction at a single tertiary-care center. From 2010 to 2012, 13 consecutive patients presenting with benign obstruction of mid-/distal ureters were managed with RAUR.
  
  
  RESULTS
  In all cases the operative procedure was undertaken with six-port transperitoneal access, and all procedures were completed robotically. All ureters (left, n=5; right, n=7; bilateral, n=1) were re-implanted in a standard Bricker fashion into the dome of the bladder with (n=8) or without (n=6) a psoas hitch. Catheters were removed 4-11 days postoperatively, and all cystograms were negative for leak. Stents were removed 14-48 days after surgery. All were negative for hydronephrosis. Average follow-up was 10 (range, 2-20) months. There were two grade 1, two grade 2, two grade 3, and no grade 4 or 5 complications in 3 patients.
  
  
  CONCLUSIONS
  RAUR is a safe and effective procedure. Extensive laparoscopic lysis of adhesions represents the primary challenge to an otherwise straightforward minimally invasive surgery. At our institution, RAUR has replaced open ureteral re-implantation as the preferred treatment for benign mid-/distal ureteral stricture disease.
authors.affiliation: Department of Urology, Eastern Virginia Medical School , Norfolk, Virginia; Urology of Virginia, LLC , Virginia Beach, Virginia.
authors.forename: Shaun E L
authors.initials: SE
authors.lastname: Wason
authors.affiliation: Department of Urology, Eastern Virginia Medical School , Norfolk, Virginia; Urology of Virginia, LLC , Virginia Beach, Virginia.
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Lance
authors.affiliation: Department of Urology, Eastern Virginia Medical School , Norfolk, Virginia; Urology of Virginia, LLC , Virginia Beach, Virginia.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Given
authors.affiliation: Department of Urology, Eastern Virginia Medical School , Norfolk, Virginia; Urology of Virginia, LLC , Virginia Beach, Virginia.
authors.forename: John B
authors.initials: JB
authors.lastname: Malcolm
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures