Robotic management of genitourinary injuries from obstetric and gynaecological operations

A multi-institutional report of outcomes

Paul T. Gellhaus, Akshay Bhandari, M. Francesca Monn, Thomas Gardner, Prashanth Kanagarajah, Christopher E. Reilly, Elton Llukani, Ziho Lee, Daniel D. Eun, Hani Rashid, Jean V. Joseph, Ahmed E. Ghazi, Guan Wu, Ronald S. Boris

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery Patients and Methods A retrospective review of all patients from four different high-volume institutions between 2002 and 2013 that had a robot-assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1-297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re-implants (11 with ipsilateral psoas hitch) and 15 uretero-ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1-63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1-26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow-up of the entire cohort was 16.6 (1-63) months. Conclusions RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.

Original languageEnglish
Pages (from-to)430-436
Number of pages7
JournalBJU International
Volume115
Issue number3
DOIs
StatePublished - Mar 1 2015

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Robotics
Obstetrics
Wounds and Injuries
Cystotomy
Obstetric Surgical Procedures
Gynecologic Surgical Procedures
Fistula
Stents
Dilatation
Ureterostomy
Cervical Cerclage
Vesicovaginal Fistula
Ovariectomy
Endometriosis
Ureter
Hysterectomy
Cesarean Section
Ligation
Urinary Bladder
Population

Keywords

  • gynaecology injury
  • robotic surgery
  • ureteroneocystostomy
  • ureterovaginal fistula
  • vesicovaginal fistula

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Robotic management of genitourinary injuries from obstetric and gynaecological operations : A multi-institutional report of outcomes. / Gellhaus, Paul T.; Bhandari, Akshay; Monn, M. Francesca; Gardner, Thomas; Kanagarajah, Prashanth; Reilly, Christopher E.; Llukani, Elton; Lee, Ziho; Eun, Daniel D.; Rashid, Hani; Joseph, Jean V.; Ghazi, Ahmed E.; Wu, Guan; Boris, Ronald S.

In: BJU International, Vol. 115, No. 3, 01.03.2015, p. 430-436.

Research output: Contribution to journalArticle

Gellhaus, PT, Bhandari, A, Monn, MF, Gardner, T, Kanagarajah, P, Reilly, CE, Llukani, E, Lee, Z, Eun, DD, Rashid, H, Joseph, JV, Ghazi, AE, Wu, G & Boris, RS 2015, 'Robotic management of genitourinary injuries from obstetric and gynaecological operations: A multi-institutional report of outcomes', BJU International, vol. 115, no. 3, pp. 430-436. https://doi.org/10.1111/bju.12785
Gellhaus, Paul T. ; Bhandari, Akshay ; Monn, M. Francesca ; Gardner, Thomas ; Kanagarajah, Prashanth ; Reilly, Christopher E. ; Llukani, Elton ; Lee, Ziho ; Eun, Daniel D. ; Rashid, Hani ; Joseph, Jean V. ; Ghazi, Ahmed E. ; Wu, Guan ; Boris, Ronald S. / Robotic management of genitourinary injuries from obstetric and gynaecological operations : A multi-institutional report of outcomes. In: BJU International. 2015 ; Vol. 115, No. 3. pp. 430-436.
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abstract = "Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery Patients and Methods A retrospective review of all patients from four different high-volume institutions between 2002 and 2013 that had a robot-assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3{\%}) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1-297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re-implants (11 with ipsilateral psoas hitch) and 15 uretero-ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1-63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1{\%}) for a mean (range) of 4.1 (1-26) days. No case required open conversion. Two patients (4.1{\%}) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow-up of the entire cohort was 16.6 (1-63) months. Conclusions RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.",
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AU - Monn, M. Francesca

AU - Gardner, Thomas

AU - Kanagarajah, Prashanth

AU - Reilly, Christopher E.

AU - Llukani, Elton

AU - Lee, Ziho

AU - Eun, Daniel D.

AU - Rashid, Hani

AU - Joseph, Jean V.

AU - Ghazi, Ahmed E.

AU - Wu, Guan

AU - Boris, Ronald S.

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N2 - Objective To evaluate the utility of robotic repair of injuries to the ureter or bladder from obstetrical and gynaecological (OBGYN) surgery Patients and Methods A retrospective review of all patients from four different high-volume institutions between 2002 and 2013 that had a robot-assisted (RA) repair by a urologist after an OBGYN genitourinary injury. Results Of the 43 OBGYN operations, 34 were hysterectomies: 10 open, 10 RA, nine vaginally, and five pure laparoscopic. Nine patients had alternative OBGYN operations: three caesarean sections, three oophorectomies (one open, two laparoscopic), one RA colpopexy, one open pelvic cervical cerclage with mesh and one RA removal of an invasive endometrioma. In all, 49 genitourinary (GU) injuries were sustained: ureteric ligation (26), ureterovaginal fistula (10), ureterocutaneous fistula (one), vesicovaginal fistula (VVF; 10) and cystotomy alone (two). In all, 10 patients (23.3%) underwent immediate urological repair at the time of their OBGYN RA surgery. The mean (range) time between OBGYN injury and definitive delayed repair was 23.5 (1-297) months. Four patients had undergone prior failed repair: two open VVF repairs and two balloon ureteric dilatations with stent placement. In all, 22 ureteric re-implants (11 with ipsilateral psoas hitch) and 15 uretero-ureterostomies were performed. Stents were placed in all ureteric cases for a mean (range) of 32 (1-63) days. In all, 10 VVF repairs and two primary cystotomy closures were performed. Drains were placed in 28 cases (57.1%) for a mean (range) of 4.1 (1-26) days. No case required open conversion. Two patients (4.1%) developed ureteric obstruction after RA repair requiring dilatation and stenting. The mean (range) follow-up of the entire cohort was 16.6 (1-63) months. Conclusions RA repair of GU injuries during OBGYN surgery is associated with good outcomes, appears safe and feasible, and can be used successfully immediately after injury recognition or as a salvage procedure after prior attempted repair. RA techniques may improve convalescence in a patient population where quick recovery is paramount.

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KW - ureteroneocystostomy

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