AB009. Robot-assisted laparoscopic psoas hitch with ureteric re-implantation for uretero-vaginal fistula following hysterectomy

Background: Robot-assisted procedures are expanding rapidly in minimally invasive urologic surgery. We demonstrate the use of da Vinci Xi dual console system for robotic-assisted psoas hitch with ureteral re-implantation.

Methods: We assembled video footage from a robotic-assisted psoas hitch followed by ureteric re-implantation procedure performed for a patient with uretero-vaginal fistula following hysterectomy.

Results: We demonstrate trocar placement and a robotic-arm docking strategy for this procedure. Surgical steps involved in a psoas hitch and reimplantation of a transected ureter into the bladder are shown. The bladder is placed on traction using the fourth arm, and the avascular planes of dissection, including the space of Retzius and the para-vesical spaces, are shown. The bladder is then distended with saline to determine the ideal placement of the ureteral reimplantation to ensure the anastomosis is tension free. The surgeon then shows where and how to place anchoring sutures from the bladder to the psoas muscle. The ureter is examined to determine where it can be implanted in the bladder with no tension or angulation. The ureter is prepared for reimplantation, including trimming, tagging, and spatulation. Extravesical anastomosis was performed over a JJ stent.

Conclusions: When superior visibility, meticulous dissection, or complex reconstruction is needed, robotic surgery may offer benefits over conventional laparoscopy and thus may avoid the morbidity of open surgical reconstruction.

Keywords: Robotic; laparoscopic; psoas-hitch; ureteric reimplantation; uretero-vaginal fistula