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Intracorporeal Double-J stent placement during robot-assisted urinary tract reconstruction: technical considerations.

Abstract：

BACKGROUND AND PURPOSE:An integral component of many urologic reconstructive surgical procedures is the positioning of a Double-J stent to span the anastomosis. Some surgeons prefer to place a retrograde stent during cystoscopy, either during or after the reconstruction. In this communication, we describe our straightforward and effective approach of performing this critical step intracorporeally using robotic assistance in a variety of upper tract urologic reconstructive procedures. PATIENTS AND METHODS:We examined our Institutional Review Board-approved database of robotic surgeries to identify reconstructive operations that included the intracorporeal placement of a Double-J stent since 2008. Our step-by-step method for stent placement during various robotic urologic reconstructions is detailed, including procedures involving the proximal, mid, and distal ureter. With the aid of a bedside assistant-surgeon, we delineate how the console surgeon is able to perform this step of the procedure completely intracorporeally, without the need for repositioning or cystoscopy. RESULTS:Since the inception of our robotic surgical program in 2008, we have used these robotic stent placement techniques in 150 patients. The average time of robotic intracorporeal stent placement across the anastomosis was 3.5 minutes. Three patients did experience proximal stent migration, as documented on postoperative radiographs, but all were treated with conservative measures, because their anastomosis was not affected and severe symptoms did not develop. No patient needed stent replacement, and each stent was subsequently removed ureteroscopically without sequelae. CONCLUSIONS:Our robotic intracorporeal Double-J stent placement approach is simple and effective, avoids the need for cystoscopy and fluoroscopy, and can be used in any type of upper urinary tract urologic reconstruction.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Mufarrij PW,Rajamahanty S,Krane LS,Hemal AK

doi

10.1089/end.2011.0296

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

1121-4

issue

eissn

0892-7790

issn

1557-900X

journal_volume

pub_type

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Intracorporeal Double-J stent placement during robot-assisted urinary tract reconstruction: technical considerations.