Journal article
Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi‐institutional report of outcomes
BJU international, Vol.115(3), pp.430-436
03/2015
DOI: 10.1111/bju.12785
PMID: 24750903
Abstract
Objective
To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery
Patients and Methods
A retrospective review of all patients from four different high‐volume institutions between 2002 and 2013 that had a robot‐assisted (RA) repair by a urologist after an OBGYN genitourinary injury.
Results
Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1–297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re‐implants (11 with ipsilateral psoas hitch) and 15 uretero‐ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1–63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1–26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow‐up of the entire cohort was 16.6 (1–63) months.
Conclusions
RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.
Details
- Title: Subtitle
- Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi‐institutional report of outcomes
- Creators
- Paul T Gellhaus - Indiana UniversityAkshay Bhandari - Columbia University at Mount SinaiM. Francesca Monn - Indiana UniversityThomas A Gardner - Indiana UniversityPrashanth Kanagarajah - Columbia University at Mount SinaiChristopher E Reilly - Temple UniversityElton Llukani - Temple UniversityZiho Lee - Temple UniversityDaniel D Eun - Temple UniversityHani Rashid - University of RochesterJean V Joseph - University of RochesterAhmed E Ghazi - University of RochesterGuan Wu - University of RochesterRonald S Boris - Indiana University
- Resource Type
- Journal article
- Publication Details
- BJU international, Vol.115(3), pp.430-436
- DOI
- 10.1111/bju.12785
- PMID
- 24750903
- ISSN
- 1464-4096
- eISSN
- 1464-410X
- Number of pages
- 7
- Language
- English
- Date published
- 03/2015
- Academic Unit
- Urology
- Record Identifier
- 9984051744502771
Metrics
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