V06-07 Robot Assisted 3d Model & Indocyanine Guided Ureteral Reimplantation in Renal Transplant Patients: 4 Emblematic Cases From Our Series

You have accessJournal of UrologyMisc. Benign/ Transplant/ Renovascular (V06)1 May 2024V06-07 ROBOT ASSISTED 3D MODEL & INDOCYANINE GUIDED URETERAL REIMPLANTATION IN RENAL TRANSPLANT PATIENTS: 4 EMBLEMATIC CASES FROM OUR SERIES Federico Lavagno, Marco Allasia, Marco Oderda, Alessandro Marquis, Daniele D'Agate, Alessandro Greco, Giuseppe Pasquale, Andrea Bosio, and Paolo Gontero Federico LavagnoFederico Lavagno , Marco AllasiaMarco Allasia , Marco OderdaMarco Oderda , Alessandro MarquisAlessandro Marquis , Daniele D'AgateDaniele D'Agate , Alessandro GrecoAlessandro Greco , Giuseppe PasqualeGiuseppe Pasquale , Andrea BosioAndrea Bosio , and Paolo GonteroPaolo Gontero View All Author Informationhttps://doi.org/10.1097/01.JU.0001010048.21113.99.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The outcomes of kidney transplants have improved significantly in recent years, leading to a reduction in morbidity and mortality. Even though, urological complications occur in the 2–10%. The ureteral stenosis of the graft ureter is the most common, with a probability of 0.5%–6.3%. Usually presenting within the first few weeks, or the first year, the most common site of stenosis is the ureterovesical junction. Several imaging are useful to assess hydronephrosis, including ultrasonography, CT, MR and scintigraphy.Once ureteric obstruction is confirmed, urinary diversion must be undertaken with a percutaneous nephrostomy insertion or a retrograde stent positioning. Definitive treatment include percutaneous balloon dilatation if technically feasible, followed by temporary ureteric stent placement. If the stenosis recurs after stent removal, surgical revision or long-term ureteric stenting is advocated. METHODS: Patients with ureteral stenosis were treated at our centre with a robot assisted technique (Da Vinci Xi), with the use of pre operative 3D models of the anatomy (Medics Srl © - Hyper Accuracy 3D®) and the auxilium of green indocyanine. Even if the scheduled intervention was the reimplantation of the ureteral graft to the bladder, this was not always possible. Step 1 is to identify and isolate the graft ureter transperitoneally with the aid of indocyanine (Firefly ™ Fluorescence Imaging for Da Vinci®) and the anastomotic stricture is transected and removed. This is often a challenging procedure due to sclerotic tissues. After the transverse opening of the isolated bladder a tension-free uretero-vesical anastomosis in single absorbable 4/0 stitches on a 6 Fr JJ ureteral stent complete the anastomosis. In other cases, as in the second video presented, due to sclerotic tissue the operation was converted to harvesting a Boari-Casati flap with the bladder mucosa. In the fourth case, intraoperatively, the transplanted ureter was found to be malacic and not useful for replanting, therefore the transplanted ureter had to be excised and the native ureter was used to create an anastomosis with the renal pelvis of the transplanted kidney. RESULTS: To date, 7 patients (5 F and 2 M) with distal graft ureteral stenosis, planned for ureteral reimplantation, were treated with a robot assisted technique (Da Vinci Xi). The mean time to onset of ureteral stricture was 3.5 months. Mean operative time was 217 minutes. Mean pre-op s-CR was 2.3 mg/dl, while post operative s-CR1.36 mg/dl. After 1 month observation mean s-CR was 1.45 mg/dl. CONCLUSIONS: Reconstructive surgery for renal transplant complications is often challenging. The transperitoneal robotic approach with the use of 3D reconstructions and indocyanine could help in the identification and isolation of the ureter. 3D guidance can also make it easier to identify the renal vessels and the pelvis. On the other hand, the high costs of robotic surgery, further burdened by the use of 3D models, need to be considered. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e378 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Federico Lavagno More articles by this author Marco Allasia More articles by this author Marco Oderda More articles by this author Alessandro Marquis More articles by this author Daniele D'Agate More articles by this author Alessandro Greco More articles by this author Giuseppe Pasquale More articles by this author Andrea Bosio More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF downloadLoading ...