title: Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.
abstract: Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach.
  
  
  
  To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres.
  
  
  
  This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014.
  
  
  
  Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques.
  
  
  
  Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed.
  
  
  
  No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population.
  
  
  
  Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results.
  
  
  
  In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures.
authors.affiliation: Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy. Electronic address: buffi.nicolomaria@gmail.com.
authors.forename: Nicolò Maria
authors.initials: NM
authors.lastname: Buffi
authors.affiliation: Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.affiliation: Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Hurle
authors.affiliation: Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
authors.affiliation: Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Taverna
authors.affiliation: Department of Urology, Humanitas Mater Domini, Castellanza, Varese, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bozzini
authors.affiliation: San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Checcucci
authors.affiliation: San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lista
authors.affiliation: Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014519:Ureterostomy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: Outcomes; Reimplantation; Robot-assisted surgery; Surgical technique; Ureter; Ureteral strictures; Ureteral surgery