title: Contemporary Series of Robotic-Assisted Distal Ureteral Reconstruction Utilizing Side Docking Position.
abstract: OBJECTIVE
  The robot-assisted approach to distal ureteral reconstruction is increasingly utilized. Traditionally, the robot is docked between the legs in lithotomy position resulting in limited bladder access for stent placement. We examined the use of side docking of the daVinci robot® to perform distal ureteral reconstruction.
  
  
  METHODS
  A retrospective review of distal ureteral reconstruction (ureteral reimplantation and uretero-ureterostomy) executed robotically was performed at a single institution by a single surgeon. The daVinci robotic® Si surgical platform was positioned at the right side of the patient facing towards the head of the patient, i.e. side docking.
  
  
  RESULTS
  A total of 14 cases were identified from 2011-2013. Nine patients underwent ureteral reimplantation for ureteral injury, two for vesicoureteral reflux, one for ureteral stricture, and one for megaureter. One patient had an uretero-ureterostomy for a distal stricture. Three patients required a Boari flap due to extensive ureteral injury. Mean operative time was 286 minutes (189-364), mean estimated blood loss was 40cc (10-200), and mean length of stay was 2.3 days (1-4). Follow-up renal ultrasound was available for review in 10/14 patients and revealed no long-term complications in any patient. Mean follow-up was 20.7 months (0.1-59.3).
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic distal ureteral reconstruction is safe and effective. Side docking of the robot allows ready access to the perineum and acceptable placement of the robot to successfully complete ureteral repair.
authors.affiliation: Department of Urology,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rick C
authors.initials: RC
authors.lastname: Slater
authors.affiliation: Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Farber
authors.affiliation: Division of Urology, University of New Mexico, Albuquerque, NM, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Riley
authors.affiliation: Department of Urology,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Shilo
authors.affiliation: Department of Urology,University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ost
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods*; D059035:Perioperative Period; D011183:Postoperative Complications; D012092:Replantation / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014519:Ureterostomy / Q000295:instrumentation / Q000379:methods; D055815:Young Adult
chemical_list: D003404:Creatinine