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Complex Robotic Assisted Lower Urinary Tract Reconstruction in Patients with Previous Open Abdominal Surgery
Patricio Gargollo, MD1, Carlos Villanueva, MD1, Candace Granberg, MD2.
1UT Southwestern Medical Center, Dallas, TX, USA, 2Mayo Clinic, Rochester, MN, USA.

Background: Minimally invasive surgery in patients with previous open abdominal surgery is usually not performed since intra-abdominal adhesions may complicate access, port placement and thusmay increase intra-abdominal injury. Here we describe our experience with robotic assisted complex lower urinary tract reconstruction (CLUTR) in patients with previous abdominal surgery.
Methods: All patients with any previous open abdominal surgery undergoing robotic assisted CLUTR were included in the study. CLUTR was definied as bladder neck reconstruction (BNR) or continent catheterizable conduits (CCC) or both. Ureteral reimplantation or uretero-ureterostomies as well as all renal surgery were excluded. Patient demographics, surgery performed, operative techniques, operative times and outcomes were assessed.
Results: 24 patients met inclusion criteria during the 2010-2013 period analyzed. 15 of these patients had multiple ventriculoperitoneal shunt revisions and 9 had major previous abdominal surgery including laparotomy with other adjunct procedures in 8 and laparotomy with colostomy in 1. All laparoscopic access was obtained with the verees needle either infraumbilically or in the left upper quadrant. There were no access injuries. There were 3 conversions. 6 patients underwent BNR with CCC and the rest CCC only. Mean operative time was 6.3 hrs (4.5-12.2 hrs). Mean length of stay (LOS) was 45 hrs ( 23-92 hrs). The first 12 cases took significantly longer than the last 12 cases (mean 8.1 hr vs mean 5.3 hr p= 0.002). Patients with multiple VP shunt revisions had a higher conversion rate and a higher mean operative time when compared to other patients (p=0.01 and p=0.002 respectively)
Conclusions: Robotic assisted CLUTR in patients with previous open abdominal surgery is safe and feasible. Longer operative times should be expected early in a surgeon’s experience. Multiple VP shunt revisions have higher conversion rates to open and longer operative times when compared to other indications for previous surgery.


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