title: Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up.
abstract: The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaramella
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy. francesco.chessa2@studio.unibo.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chessa
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
authors.forename: Cristian Vincenzo
authors.initials: CV
authors.lastname: Pultrone
authors.affiliation: Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Palagi 9 Street, 40134, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Borghesi
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cocci
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Chindemi
authors.affiliation: Department of Urology, University of Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Urology, University of Brescia, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Department of Urology, University of Bari "Aldo Moro", Bari, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pagliarulo
authors.affiliation: Department of Urology, Ospedale "Carlo Poma" Mantova, Mantova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Parma
authors.affiliation: Department of Urology, Ospedale "Carlo Poma" Mantova, Mantova, Italy.
authors.forename: Alessanrdo
authors.initials: A
authors.lastname: Samuelli
authors.affiliation: Dept. Of Urology, Ospedale "San Bassiano", Bassano del Grappa, VI, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Celia
authors.affiliation: Dept. Of Urology, Ospedale "San Bassiano", Bassano del Grappa, VI, Italy.
authors.forename: Bernardino
authors.initials: B
authors.lastname: De Concilio
authors.affiliation: Department of Urology, Policlinico Di Milano, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.affiliation: Department of Urology, Policlinico Di Milano, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: De Lorenzis
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
authors.affiliation: Department Of Urology, University of Eastern Piedmont Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Department of Urology, Policlinico Vittorio Emanuele, Catania, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Falsaperla
authors.affiliation: Department of Urology, Policlinico Di Abano, Abano Terme, PD, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Dente
authors.affiliation: Department of Urology, Policlinico Di Abano, Abano Terme, PD, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Porreca
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*
keywords: Laparoscopy; Reconstructive surgical procedures; Robotics; Stenosis; Ureter; Ureteral obstruction