经低前通道的单端口机器人辅助输尿管再植：一步一步的程序和初步的比较结果

IF 4.5 3区医学 Q1 UROLOGY & NEPHROLOGY

European Urology Open Science Pub Date : 2025-07-12 DOI:10.1016/j.euros.2025.06.002

Luca Lambertini , Giulio Avesani , Hakan Bahadir Haberal , Juan Ramon Torres Anguiano , Ruben Sauer Calvo , Luca Morgantini , Andrea Minervini , Simone Crivellaro

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引用次数: 0

摘要

背景与目的输尿管远端狭窄的多通道机器人治疗仍然受到强制性经腹腔入路和患者陡峭的Trendelenburg体位的困扰。我们的目的是描述通过仰卧位腹腔外入路接受单端口机器人辅助输尿管再植术（SP-RAUR）治疗的最大系列患者，重点关注手术技术、围手术期手术结果和功能结果。前瞻性收集2021年1月至2023年9月期间连续接受SP-RAUR治疗的所有成年患者的临床和手术资料。患者按手术入路分为低前路（LAA）组和经腹腔（TP）组。输尿管再植术采用仰卧位腹膜外行。总体而言，20例接受SP-RAUR且至少随访1年的患者被纳入分析，其中50%通过LAA方法治疗。两组间基线特征无显著差异。无开放性转换及术中并发症发生。LAA组手术时间短于TP组(165 min vs 191 min；p = 0.01)。在围手术期特征方面，LAA入路术后疼痛和阿片类药物使用较低，住院时间较短(8 vs 26.5 h；p = 0.016)。中位随访14.5个月后，无重大术后并发症或复发性尿路梗阻。结论及临床意义经LAA行sp - raur是一种可行且安全的手术，有可能改善输尿管远端狭窄患者的围手术期恢复。我们评估了一种新的机器人辅助手术技术，用于治疗将尿液从肾脏排入膀胱的管道变窄。这种技术只需要一个小切口。我们的结果表明，手术是安全的，病人恢复很快，很快就能恢复日常活动。需要更多患者参与的更大规模研究来证实这些结果。

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Single-port Robot-assisted Ureteral Reimplantation via Low Anterior Access: Step-by-step Procedure and Preliminary Comparative Results

Background and objective

Multiport robotic management of distal ureteral strictures is still burdened by the mandatory transperitoneal approach and the steep Trendelenburg patient position. Our aim was to describe the largest series of patients treated with single-port robot-assisted ureteral reimplantation (SP-RAUR) via a supine extraperitoneal approach, with a focus on the surgical technique, perioperative surgical outcomes, and functional results.

Methods and surgical procedure

Clinical and surgical data for all consecutive adult patients treated with SP-RAUR between January 2021 and September 2023 were prospectively collected. Patients were stratified by surgical approach into low anterior access (LAA) and transperitoneal (TP) groups. Ureteral reimplantation was performed extraperitoneally with patients in a supine position.

Key findings and limitations

Overall, 20 patients who underwent SP-RAUR and had minimum follow-up of 1 yr were included in the analysis, of whom 50% were treated via an LAA approach. There were no significant differences in baseline characteristics between the groups. No open conversions or intraoperative complications occurred. The operative time was shorter in the LAA group than in the TP group (165 vs 191 min; p = 0.01). In terms of perioperative features, the LAA approach was associated with lower postoperative pain and opioid use and shorter length of stay (8 vs 26.5 h; p = 0.016). No major postoperative complications or recurrent urinary obstruction were observed after median follow-up of 14.5 mo.

Conclusions and clinical implications

SP-RAUR via LAA represents a feasible and safe procedure with potential to improve perioperative recovery for patients with a distal ureter stricture.

Patient summary

We assessed a new robot-assisted surgery technique to treat narrowing of the tube that drains urine from the kidney into the bladder. This technique uses just a single small incision. Our results show that the procedure is safe and that patients have a quick recovery and a fast return to everyday activities. Larger studies with more patients are needed to confirm these results.

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