Clinical
Research Methods / Techniques
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Benoit Peyronnet
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Abstract Centre
Ureteral stricture is a well-known complication of ureteroscopy, especially if the procedure is repeated. There is still no clear consensus on the best way to manage those iatrogenic strictures. Robotic buccal mucosa graft ureteroplasty has recently been described as a promising option for mid or upper ureter stricture 2 to 10 cm.
We present the case of a 42 year-old male, with a iatrogenic ureteral stricture after 4 ureteroscopies for ureteral stone treatment. One attempt of endoscopic incision failed. The stricture was 3cm long, located at the iliac ureter level, with residual stone fragment stucked in the ureteral wall. The aim of this video was to describe the procedure of robot assisted buccal mucosa graft ureteroplasty
The procedure was supervised by an international expert in reconstructive urology by telementoring. The operating time was 180 minutes. The procedure begins by the identification of the left ureter. The intravenous injection of indocyanine green helped to visualize the proper vascularization of the ureter above and below the level of the stricture using FireFly™ Near Infrared Fluorescence Once the stricture was sized a second team began to harvest the buccal mucosa graft in a standard fashion. The anterior aspect of the ureteral stricture was cut open longitudinally, until a 9CH flexible ureteroscope could be passed through. Flexible ureteroscopy ensured the quality of the tissues on both sides of the stricture. A double-J stent was placed. The graft was sutured on the ureteral incision area by two running sutures of 5/0 Pds. At the end of the procedure, omentum was suture onto the graft to provide adequate blood supply. No peri operative complication occurred. The patient was discharged two days after surgery and did not have recurrence of stenosis after double J-stent removal.
Robotic buccal Mucosa graft ureteroplasty is a feasible procedure and could decrease the perioperative morbidity compared to the existing surgical options. Innovative technologies such as the FireFly™ NIRF can be helpful for this procedure.