Three robotic surgery specialists will share their expertise during a Monday morning surgical techniques session titled Tips & Tricks: Robotic Reconstruction of the Ureter. The 45-minute presentation will begin at 10:45 am during the Prime Time plenary session in the Esplanade Ballroom at Moscone South.
Daniel Eun, MD, professor of Urology and Director of Minimally Invasive Robotic Urologic Oncology and Reconstructive Surgery at the Lewis Katz School of Medicine at Temple University Hospital, will share robotic surgery techniques he’s refined in the last decade.
“We’re currently in the midst of creating a new paradigm of complex repair of the ureter,” he said. “Historically speaking, most of the work we’re now doing using robotic surgery has been viewed as techniques in the realm of open surgery. However, since I started my practice in 2008, I’ve tackled more and more complex ureteral reconstruction cases using minimally invasive techniques with the robot. Over the years, I’ve realized these complex cases can be done through new means and do not necessarily require open surgery.”
Dr. Eun will review a near-infrared fluorescence imaging technology he uses in novel ways to solve complex ureteral reconstruction cases.
“In complex ureteral reconstruction cases the ureter can be completely fibrotic and fused to the retroperitoneum, and therefore difficult to identify,” Dr. Eun said. “By injecting indocyanine green (ICG) directly into the ureter and switching to the near-infrared mode, the ureter lights up bright green. It almost looks like a lit-up runway showing us the way.”
Dr. Eun noted this is an off-label use of ICG. He will also discuss other uses for ICG, as well as robotic buccal mucosa ureteroplasty.
“The field of ureteral reconstruction surgery has really taken a step forward with exciting new technologies and techniques,” he said. “We now have less radical options to solve these challenging problems.”
Andre Berger, MD, assistant professor of Urology and Robotic & Laparoscopic Surgery at the University of Southern California, will also share insights on reconstructive robotic surgery, including ileal ureter procedures.
“This is an intense topic because even in open surgery just a few surgeons have experience in complex reconstructive procedures,” Dr. Berger said. “Traditionally, repair of the ileal ureter is a long operation with many steps. We propose that it can be done robotically to hopefully minimize the risk of complications and speed recovery for patients.”
At the University of Southern California, near-infrared fluorescence imaging technology and ICG are used to evaluate bowel and ureteral vascularization. Dr. Berger said preliminary data suggest that the technology can guide surgeons during distal ureteral resection, decreasing ureteral stricture rate in intracorporeal urinary diversions after robotic radical cystectomies.
He will review how his team uses a robotic system that allows him to complete the procedure without repositioning the patient or the robot, significantly decreasing the length of the procedure.
Patricio Gargollo, MD, associate professor at the Mayo Clinic, will discuss robotic surgery from a pediatric perspective. He will share data he’s published on robotic ureteral reimplantation for vesicoureteral reflux.
“This condition is a lot more common in pediatrics, but it’s certainly seen in the adult world as well,” he said. “We get into a lot of debates about this, but the initial data suggest that robotic-assisted ureteral reimplantation has a lower success rate, potentially a higher complication rate and a longer anesthesia time. The longer anesthesia time is really important in pediatrics because studies show prolonged anesthesia may be detrimental to the developing brain.”
Dr. Gargollo will also address the cosmetic aspect of robotic ureteral surgery.
“It’s important we make our incisions as cosmetically pleasing as possible, and robotic-assisted ureteral reimplantation in children, depending on how you do it, can potentially leave visible scarring,” he said. “So with this particular procedure, when compared to open surgery you’re looking at possibly having a lower success rate, a potentially higher complication rate, less cosmetically pleasing scar parameters, higher costs and longer anesthetic time.”