Robot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine model
| Autor: | Shubha De, Robert J. Stein, Oktay Akca, Cristina Magi-Galluzzi, Humberto Laydner, Luis Felipe Brandao, Jayram Krishnam, Riccardo Autorino, Jihad H. Kaouk, Cassio Andreoni, Patil Pallavi, Homayoun Zargar, Manoj Monga |
|---|---|
| Přispěvatelé: | Brandao, Luis Felipe, Laydner, Humberto, Akca, Oktay, Autorino, Riccardo, Zargar, Homayoun, De, Shubha, Krishnam, Jayram, Pallavi, Patil, Monga, Manoj, Stein, Robert J., Magi-Galluzzi, Cristina, Andreoni, Cassio, Kaouk, Jihad H. |
| Rok vydání: | 2016 |
| Předmět: |
Male
Nephrology Swine Sus scrofa 030232 urology & nephrology Tubularized peritoneal flap Constriction Pathologic urologic and male genital diseases Surgical Flaps 0302 clinical medicine Vascularity Robotic Surgical Procedures Suture (anatomy) Ureteral Diseases Kidney Pelvis Myofibroblasts Neoureter Stem cell Mesenchymal Stromal Cell Cell Differentiation Robot-assisted Mesothelium Ureteral Disease medicine.anatomical_structure 030220 oncology & carcinogenesis Models Animal Urologic Surgical Procedures Peritoneum medicine.symptom Renal pelvis Robotic Surgical Procedure Reconstructive surgery medicine.medical_specialty Urology 03 medical and health sciences Kidney Pelvi Ureter Minimally invasive surgery Internal medicine medicine Animals Reconstructive Surgical Procedure Tissue engineering Robotic surgery Urothelium Myofibroblast Animal urogenital system business.industry Mesenchymal Stem Cells Plastic Surgery Procedures Surgery Feasibility Studie Surgical Flap Ureter reconstruction Urologic Surgical Procedure Feasibility Studies business |
| Zdroj: | World Journal of Urology. 35:89-96 |
| ISSN: | 1433-8726 0724-4983 |
| Popis: | Objective: To evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. Materials and methods: Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6â9 weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. Results: All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162â360). Flap tubularization suture took 31 min (19â47), and proximal anastomosis took 20 min (15â38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7â12) and 23 min (13â46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p = 0.003). Conclusions: Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink