Robotic Urological Procedures in Gynaecology

There exists huge overlap in urological and gynaecological surgery, due to their anatomical proximity. An understanding of surgical anatomy, the general principles of urological surgery and specific robotic techniques is essential for the gynaecological surgeon to ensure preservation of urinary tract integrity and its reconstruction where necessary. This is of particular importance in cases such as pelvic organ prolapse and pelvic fistulae or direct involvement of the urinary tract by gynaecological pathology such as advanced malignancy, previous radiotherapy or severe endometriosis, to avoid potential iatrogenic bladder or ureteric injury. The da Vinci® Surgical System has applications in the surgical management of an increasing array of related urological and gynaecological procedures. This chapter will address the surgical technique and reported outcomes to date of robot-assisted, simple and partial cystectomy, urinary diversion, augmentation cystoplasty and vesicovaginal fistula repair. We also explore the role of robotic surgery in managing urinary tract injury and reconstruction, with a particular focus on principles of ureteric handling and mobilisation, reconstruction techniques and stenting, with guidance on avoiding damage to the urinary tract. Similar content being viewed by others

Murphy D, Challacombe B, Khan MS, Dasgupta P. Robotic technology in urology. Postgrad Med J. 2006;82(973):743–7. https://doi.org/10.1136/pgmj.2006.048140. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408–10. Khosla A, Wagner AA. Robotic surgery of the kidney, bladder, and prostate. Surg Clin North Am. 2016;96(3):615–36. https://doi.org/10.1016/j.suc.2016.02.015. Rogers CG, Singh A, Blatt AM, et al. Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol. 2008;53(3):514–23. Benway BM, Wang AJ, Cabello JM, Bhayani SB. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol. 2009;55(3):592–9. Kaczmarek BF, Tanagho YS, Hillyer SP, et al. Off-clamp robot-assisted partial nephrectomy preserves renal function: a multi-institutional propensity score analysis. Eur Urol. 2013;64(6):988–93. Ahmed K, Khan SA, Hayn MH, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65(2):340–7. Abraham JB, Young JL, Box GN, et al. Comparative analysis of laparoscopic and robot-assisted radical cystectomy with ileal conduit urinary diversion. J Endourol. 2007;21(12):1473–80. https://doi.org/10.1089/end.2007.0095. Walz J, Epstein J, Ganzer R, et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol. 2016;70(2):301–11. https://doi.org/10.1016/j.eururo.2016.01.026. Einarsson JI, Hibner M, Advincula AP. Side docking: an alternative docking method for gynecologic robotic surgery. Rev Obstet Gynecol. 2011;4(3–4):123–5. Brandao LF, Autorino R, Zargar H, et al. Robotic ileal ureter: a completely intracorporeal technique. Urology. 2014;83(4):951–4. https://doi.org/10.1016/j.urology.2013.11.035. Sameer C, Charles M, Raj S, et al. Initial series of four-arm robotic completely intracorporeal ileal ureter. J Endourol. 2016;30(4):395–9. Frober R. Surgery illustrated: surgical atlas, surgical anatomy of the ureter. BJU Int. 2007;100(4):949–65. Moore KL, Dalley AF. Clinically oriented anatomy. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. Intuitive Surgical 2014. EndoWrist/Single-Site Instrument and Accessory Catalog. http://wwwintuitivesurgicalcom/products/871145_Instrument_Accessory_%20Catalogpdf. Accessed 3 Sept 2016. Ramirez D, Ganesan V, Nelson RJ, Haber GP. Reducing costs for robotic radical prostatectomy: three-instrument technique. Urology. 2016;95:213–5. https://doi.org/10.1016/j.urology.2016.03.067. Challacombe B, Dasgupta P. Reconstruction of the lower urinary tract by laparoscopic and robotic surgery. Curr Opin Urol. 2007;17:390–5. Stolzenburg JU, Katsakiori PF, Liatsikos EN. Role of laparoscopy for reconstructive urology. Curr Opin Urol. 2006;16:413–8. Rassweiler J, Gozen AS, Teber D, et al. Ureteral reimplantation for management of ureteral strictures: a retrospective analysis of laparoscopic and open techniques. Eur Urol. 2007;51:512–23. Gozen AS, Cresswell J, Canda AE, et al. Laparoscopic ureteral reimplantation: prospective evaluation of medium term results and current developments. World J Urol. 2010;28(2):221–6. Yohannes P, Chiou RK, Pelinkovic D. Pure robot-assisted laparoscopic ureteral reimplantation for ureteral stricture disease: case report. J Endourol. 2003;17:891–3. Hemal AK, Nayyar R, Gupta NP, Dorairajan LN. Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies. Urology. 2010;76:1387–93. Patil NN, Mottrie A, Sundaram B, Patel VR. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation. Urology. 2008;72:47–50. Phillips EA, Wang DS. Current status of robot-assisted laparoscopic ureteral reimplantation and reconstruction. Curr Urol Rep. 2012;13:190–4. Marien T, Bjurlin MA, Wynia B, et al. Outcomes of robotic-assisted laparoscopic upper urinary tract reconstruction: 250 consecutive patients. BJU Int. 2015;116(4):604–11. Gellhaus PT, Bhandari A, Monn MF, et al. Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi-institutional report of outcomes. BJU Int. 2014;115(3):430–6. Stolzenburg JU, Rai BP, Do M, et al. Robotic assisted technique for Boari flap ureteral reimplantation (RA-BFUR): replicating the techniques of open surgery in robotics. BJU Int. 2016;118(3):482–4. https://doi.org/10.1111/bju.13502. Stein R, Rubenwolf P, Ziesel C, et al. Psoas hitch and Boari flap ureteroneocystostomy. BJU Int. 2013;112(1):137–55. Isac W, Kaouk J, Altunrende F, et al. Robot-assisted ureteroneocystostomy: technique and comparative outcomes. J Endourol. 2013;27:318–23. Zee RS, Anthony Herdon CD, Smith-Harrison LI, Corbett ST. V10-05 robotic-assisted laparoscopic transureteroureterostomy. J Urol. 2014;191(4):e907–8. Ma LL, Bi H, Hou XF, et al. Laparoendoscopic single-site radical cystectomy and urinary diversion: initial experience in china using a homemade single-port device. J Endourol. 2012;26(4):355–9. https://doi.org/10.1089/end.2011.0300. Rodríguez AR, Lockhart A, King J, et al. Cutaneous ureterostomy technique for adults and effects of ureteral stenting: an alternative to the ileal conduit. J Urol. 2011;186(5):1939–43. Elands S, Vasdev N, Tay A, Adshead JM. Robot-assisted laparoscopic bladder diverticulectomy and ureteral re-implantation for a diverticulum containing high grade transitional cell carcinoma. Curr Urol. 2015;8(2):104–8. Eigner EB, Freiha FS. The fate of the remaining bladder following supravesical diversion. J Urol. 1990;144(1):31–3. LaFontaine P, Petros JA. Simple and partial cystectomy. In:Glenn’s urologic surgery. 5th ed. Philadelphia: Lippincott-Raven; 1998. p. 181–6. Le Carpentier M, Merlot B, Bot Robin V, et al. Partial cystectomy for bladder endometriosis: robotic assisted laparoscopy versus standard laparoscopy. Gynecol Obstet Fertil. 2016;44(6):315–21. Nap AW, Wijnberger L, Wijburg C. Robot-assisted partial cystectomy for bladder endometriosis. J Robot Surg. 2014;8(4):393–6. Wiklund NP, Poulakis V. Robotic neobladder. BJU Int. 2011;107(9):1514–37. Kouba E, Sands M, Lentz A, et al. A comparison of the Bricker versus Wallace ureteroileal anastomosis in patients undergoing urinary diversion for bladder cancer. J Urol. 2007;178(3):945–8. Studer UE, Turner WH. The ileal orthotopic bladder. Urology. 1995;45:185–9. Collins JW, Hosseini A, Sooriakumaran P, et al. Tips and tricks for intracorporeal robot-assisted urinary diversion. Curr Urol Rep. 2014;15(11):457. https://doi.org/10.1007/s11934-014-0457-7. Tan WS, Sridhar A, Goldstraw M, et al. Robot-assisted intracorporeal pyramid neobladder. BJU Int. 2015;116(5):771–9. https://doi.org/10.1111/bju.13189. Van Velthoven RF, Ahlering TE, Peltier A, et al. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003;61:699–702. Hosseini A, Adding C, Nilsson A, et al. Robotic cystectomy: surgical technique. BJU Int. 2011;108(6):962–8. Haddad RL, Richard P, Bladou F. Canada’s first robotic-assisted totally intracorporeal orthotopic ileal neobladder. Can Urol Assoc J. 2013;7(7–8):E537–42. Anderson CB, Cookson MS, Chang SS, et al. Voiding function in women with orthotopic neobladder urinary diversion. J Urol. 2012;188(1):200–4. Rouanne M, Legrand G, Neuzillet Y, et al. Long-term women-reported quality of life after radical cystectomy and orthotopic ileal neobladder reconstruction. Ann Surg Oncol. 2014;21(4):1398–404. Veeratterapillay R, Thorpe AC, Harding C. Augmentation cystoplasty: contemporary indications, techniques and complications. Indian J Urol. 2013;29(4):322–7. Kang IS, Lee JW, Seo IY. Robot-assisted laparoscopic augmentation ileocystoplasty: a case report. Int Neurourol J. 2010;14(1):61–4. Lee R, Symmonds R, Williams T. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3):313–9. Sotelo R, Moros V, Clavijo R, Poulakis V. Robotic repair of vesicovaginal fistula (VVF). BJU Int. 2012;109(9):1416–34. Sundaram BM, Kalidasan G, Hemal AK. Robotic repair of vesicovaginal fistula: a case series of 5 patients. Urology. 2006;65(5):970–3. Agrawal V, Kucherov V, Bendana E, et al. Robot-assisted laparoscopic repair of vesicovaginal fistula: a single-center experience. Urology. 2015;86(2):276–81. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Electronic Supplementary Material Left ureteric mobilisation and division (MOV 189 bytes) Bladder mobilisation (MOV 189 bytes) Left ureteric stenting (MOV 189 bytes) Left ureteric reimplantation (MOV 189 bytes) Rights and permissions Copyright information © 2018 Springer International Publishing AG About this chapter Cite this chapter Wright, A.E., Ubee, S., Sahadevan, K., Cooke, P.W. (2018). Robotic Urological Procedures in Gynaecology. In: El-Ghobashy, A., Ind, T., Persson, J., Magrina, J. (eds) Textbook of Gynecologic Robotic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-63429-6_20 Download citation DOI: https://doi.org/10.1007/978-3-319-63429-6_20 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-63428-9 Online ISBN: 978-3-319-63429-6 eBook Packages: MedicineMedicine (R0)