November 2017 Robotic Surgeons Council of India KS Video Awards entry from Dr. Abishek Singh, Muljibhai Patel Urological Hospital, Nadiad, India.
Ureteral stricture resulting from chronic inflammations like tuberculosis, recurrent stone disease, multiple endourological interventions are complex in nature, these may lead to severe adhesions to surrounding structures. Endourological management of these cases is difficult with poorer outcomes. In such situations, reconstructive surgical corrections remain a reliable option. The literature is replete with number of case reports describing this procedure with the open surgical approach. There are a few case reports in which the robotic platform is used for the treatment of complex ureteral strictures using the buccal mucosal graft as a tube or a onlay flap . We describe use of the BMG as onlay and inlay graft , instead of the conventional onlay or tube in ureteral stricture reconstruction, using a robotic platform.
Material and Method:
We describe a case of 60 year old diabetic lady who presented with upper ureteric stricture. Patient was evaluated by detailed history taking, physical examination, complete serum chemistries and a Computed Tomography intra-venous urography (CT- IVU). A percutaneous nephrostomy was placed and nephrostogram and retrograde ureterogram was done to delineate the stricture. Robotic assisted buccal mucosal graft ureteroplasty was done and result analysed.
Robotic buccal mucosal graft inlay and onlay ureteroplasty is a novel technique in the management of ureteral stricture. The dual graft offers an advantage of placing the graft on a robust backing thus increasing the chance of vascularization and uptake of the graft. It has a low potential for morbidity as it does not involve bowel anastomosis. Although the result of this procedure is encouraging with 3 months follow-up, more cases and longer follow-up needs for better perfection of this procedure.
Dr. Abhishek Singh : MCH Urology, Consultant Urologist, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. Email id : email@example.com
Dr. Arvind Ganpule : DNB Urology, Consultant Urologist, Vice Chairman dept. of urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. Email id: firstname.lastname@example.org
Dr.Mohammed Rafiqul Islam: MD. , Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. SIU fellow, Email Id: email@example.com
Dr. Parag Sonawane : M.S, resident department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. Email Id: firstname.lastname@example.org
Dr. Ravindra Sabnis: MCH Urology, Chairman Department of Urrology.
Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. Email Id: email@example.com
Dr. Mahesh Desai: FRCS Urology, Managing Trustee, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. Email Id: firstname.lastname@example.org
Acknowledgement : Mr. Sanjay Bhagat, Theater technician for helping us develop this technique .
Narrated robotic surgery video with additional PowerPoints and photos, 07:48