Objective: To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. Materials and methods: Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6â9Â weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. Results: All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223Â min (162â360). Flap tubularization suture took 31Â min (19â47), and proximal anastomosis took 20Â min (15â38). Bladder mobilization with psoas hitch and distal anastomosis took 9Â min (7â12) and 23Â min (13â46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (pÂ =Â 0.003). Conclusions: Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.
|Titolo:||Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model|
|Data di pubblicazione:||2017|
|Appare nelle tipologie:||1.1 Articolo in rivista|