Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model

Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model

Author Brandao, Luis Felipe Autor UNIFESP Google Scholar
Laydner, Humberto Google Scholar
Akca, Oktay Google Scholar
Autorino, Riccardo Google Scholar
Zargar, Homayoun Google Scholar
De, Shubha Google Scholar
Krishnam, Jayram Google Scholar
Pallavi, Patil Google Scholar
Monga, Manoj Google Scholar
Stein, Robert J. Google Scholar
Magi-Galluzzi, Cristina Google Scholar
Andreoni, Cassio Autor UNIFESP Google Scholar
Kaouk, Jihad H. Google Scholar
Abstract 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. Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9 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. All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162-360). Flap tubularization suture took 31 min (19-47), and proximal anastomosis took 20 min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7-12) and 23 min (13-46), 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 (p = 0.003). 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.
Keywords Ureter reconstruction
Robotic surgery
Tubularized peritoneal flap
Neoureter
Robot-assisted
Reconstructive surgery
Minimally invasive surgery
Tissue engineering
Peritoneum
Stem cells
Mesothelium
xmlui.dri2xhtml.METS-1.0.item-coverage New York
Language English
Sponsor Urology department and Research Program Committee from Cleveland Clinic
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
School of medicine of Federal University of Sao Paulo (EPM-UNIFESP, Brazil)
Date 2017
Published in World Journal Of Urology. New York, v. 35, n. 1, p. 89-96, 2017.
ISSN 0724-4983 (Sherpa/Romeo, impact factor)
Publisher Springer
Extent 89-96
Origin http://dx.doi.org/10.1007/s00345-016-1840-4
Access rights Closed access
Type Article
Web of Science ID WOS:000392317200012
URI https://repositorio.unifesp.br/handle/11600/56494

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