Patrick Selph

Robotic ureteral reconstruction distal to the ureteropelvic junction: a large single institution clinical series with short-term follow up.

BACKGROUND AND PURPOSE Use of the robotic platform for urinary reconstructive surgery is growing in popularity since its initial application with pyeloplasty for ureteropelvic junction (UPJ) repair. Although clinical series of adult robotic ureteral reconstruction appear in the literature, these reports tend to be limited in size and scope. We present the largest series to date of patients undergoing surgery for any obstruction distal to the UPJ along with outcomes and short-term follow up. PATIENTS AND METHODS A retrospective chart review was performed for patients undergoing robotic ureteral reconstructive procedures for any indication at our institution. Patients undergoing pyeloplasty, planned open procedures, and pediatric patients were excluded from the current analysis. Patient demographic data, etiology, procedure performed, and perioperative outcomes were reviewed. Postoperative follow up, imaging, and any re-interventions were also captured. The procedures performed included ureteroneocystostomy, psoas hitch, Boari flap, ureteroureterostomy, ureterolysis, ureterolithotomy, and nephropexy. RESULTS A total of 55 patients underwent robotic ureteral reconstructive procedures distal to the UPJ. Of these patients, 45 underwent intervention for a benign etiology and 10 for upper tract malignancy. All cases were successfully completed robotically with no open conversions and no intraoperative complications. Concurrent endoscopy was performed in 31 patients. The median operating room time was 221 minutes overall. Median blood loss was 50 ml with no intraoperative transfusions. The average hospital stay was 1.6 days, with 39 patients (71%) discharged on postoperative day 1. All surgical margins were negative for malignancy. The median follow up with imaging was 181 days. There were two serious complications (3.6%) and three failures (5.3%). CONCLUSIONS Robotic reconstruction of the ureter distal to the UPJ is feasible, safe, effective, and able to replicate techniques of open surgery with equivalent outcomes to large robotic pyeloplasty and smaller distal ureteral reconstruction series.

1213 THE EVALUATION OF THE LEARNING CURVE ASSOCIATED WITH ROBOTIC RADICAL CYSTECTOMY: INITIAL 100 CASES

mains one of the most effective treatment for patients with localized, invasive bladder cancer. However, little study has been undertaken to evaluate less-invasive surgical approaches to this disease. Utilizing our mature experience with robotic-assisted laparoscopic radical cystectomy (RRC), we analyzed the changes in peri-operative outcomes that may reflect progress along the learning curve. METHODS: 100 patients underwent radical cystectomy and urinary diversion at our institution from 1-06‐8/08 for clinically-localized bladder cancer. Operative outcomes, pathological results, and complications were stratified by quintiles with 20 cases in each group. Multiple paired regression models were also constructed t evaluate co-variates predictive of changes or breakpoints in the learning curve. Statistical analysis was performed using SAS version 9.2 (Cary, NC). RESULTS: Table shows the mean outcomes based on time during the experience. Statistical cutpoint for OR time occurred at case 20. On multivariate analysis, statistical cutpoint for EBL was noted at the 20th case, with no significant changes thereafter. With regard to OR time, a statistical cutpoint was noted at the 40th case. No significant changes were noted for LN count, complication rates, bowel function, or length of stay. CONCLUSIONS: Our evolving experience with robotic radical cystectomy appears to be favorable with reduction in blood loss and operative times with increasing experience. These results come in the face of applying this technique to older patients with increased comorbidities.