Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy
Purpose To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios. Methods From March 2018 to January 2020, 53 patients with lo...
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Veröffentlicht in: | International urology and nephrology 2021-03, Vol.53 (3), p.479-488 |
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creator | Cheng, Sida Fan, Shubo Wang, Jie Xiong, Shengwei Li, Xinfei Xu, Yangyang Li, Zhihua Guan, Hua Zhang, Peng Zhu, Hongjian Huang, Chen Zhang, Lei Yang, Kunlin Li, Xuesong Zhou, Liqun |
description | Purpose
To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.
Methods
From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.
Results
A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (
P
= 0.008), shorter postoperative hospital stay (
P
= 0.011) but higher hospital cost (
P
|
doi_str_mv | 10.1007/s11255-020-02679-5 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2449962948</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2449962948</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-2c7a58b06de0eb6fd57e8c8f85cdfbeac3889f020895cf5c4e7176a00014629b3</originalsourceid><addsrcrecordid>eNp9kcFu1DAQhi0EokvhBTggS1x6CdhxnDjcUEVppZW4tGfLccYhlWMH25G6T8OrMu0uIHHgYHns-WY8_n9C3nL2gTPWfcyc11JWrGa42q6v5DOy47ITVS1V85zsmGC84m0tzsirnO8ZY71i7CU5E4KJTtZ8R37uzWpSzDaus6UmjDTFIRaMtwQFUly9yeVAtzyHicbgzYE6b1YaE52ScYU6jMp3oIsJZoIFQqHRUR8RX1N8mBfjH-FlHkcPp654lUuabcFj_kTjlig8rJBmCBaepsC0KTAdXpMXzvgMb077Obm7-nJ7eV3tv329ufy8ryx-pFS17YxUA2tHYDC0bpQdKKucknZ0AxgrlOodKqV6aZ20DXS8aw0qwpu27gdxTi6OfXHmHxvkopc5W_DeBIhb1nXT9D2SjUL0_T_oPX4g4HRI9QItaVWLVH2kLKqbEzi9JtQiHTRn-tE-fbRP41D6yT4tsejdqfU2LDD-KfntFwLiCGRMhQnS37f_0_YX3bapLQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2493255686</pqid></control><display><type>article</type><title>Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy</title><source>SpringerLink Journals - AutoHoldings</source><creator>Cheng, Sida ; Fan, Shubo ; Wang, Jie ; Xiong, Shengwei ; Li, Xinfei ; Xu, Yangyang ; Li, Zhihua ; Guan, Hua ; Zhang, Peng ; Zhu, Hongjian ; Huang, Chen ; Zhang, Lei ; Yang, Kunlin ; Li, Xuesong ; Zhou, Liqun</creator><creatorcontrib>Cheng, Sida ; Fan, Shubo ; Wang, Jie ; Xiong, Shengwei ; Li, Xinfei ; Xu, Yangyang ; Li, Zhihua ; Guan, Hua ; Zhang, Peng ; Zhu, Hongjian ; Huang, Chen ; Zhang, Lei ; Yang, Kunlin ; Li, Xuesong ; Zhou, Liqun</creatorcontrib><description>Purpose
To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.
Methods
From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.
Results
A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (
P
= 0.008), shorter postoperative hospital stay (
P
= 0.011) but higher hospital cost (
P
< 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches.
Conclusion
Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.</description><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-020-02679-5</identifier><identifier>PMID: 33037521</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Hospital costs ; Laparoscopy ; Medicine ; Medicine & Public Health ; Mucosa ; Nephrology ; Robotics ; Standardization ; Stricture ; Urology ; Urology - Original Paper</subject><ispartof>International urology and nephrology, 2021-03, Vol.53 (3), p.479-488</ispartof><rights>Springer Nature B.V. 2020</rights><rights>Springer Nature B.V. 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-2c7a58b06de0eb6fd57e8c8f85cdfbeac3889f020895cf5c4e7176a00014629b3</citedby><cites>FETCH-LOGICAL-c375t-2c7a58b06de0eb6fd57e8c8f85cdfbeac3889f020895cf5c4e7176a00014629b3</cites><orcidid>0000-0003-1591-9581</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-020-02679-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-020-02679-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33037521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Sida</creatorcontrib><creatorcontrib>Fan, Shubo</creatorcontrib><creatorcontrib>Wang, Jie</creatorcontrib><creatorcontrib>Xiong, Shengwei</creatorcontrib><creatorcontrib>Li, Xinfei</creatorcontrib><creatorcontrib>Xu, Yangyang</creatorcontrib><creatorcontrib>Li, Zhihua</creatorcontrib><creatorcontrib>Guan, Hua</creatorcontrib><creatorcontrib>Zhang, Peng</creatorcontrib><creatorcontrib>Zhu, Hongjian</creatorcontrib><creatorcontrib>Huang, Chen</creatorcontrib><creatorcontrib>Zhang, Lei</creatorcontrib><creatorcontrib>Yang, Kunlin</creatorcontrib><creatorcontrib>Li, Xuesong</creatorcontrib><creatorcontrib>Zhou, Liqun</creatorcontrib><title>Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description>Purpose
To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.
Methods
From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.
Results
A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (
P
= 0.008), shorter postoperative hospital stay (
P
= 0.011) but higher hospital cost (
P
< 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches.
Conclusion
Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.</description><subject>Hospital costs</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mucosa</subject><subject>Nephrology</subject><subject>Robotics</subject><subject>Standardization</subject><subject>Stricture</subject><subject>Urology</subject><subject>Urology - Original Paper</subject><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kcFu1DAQhi0EokvhBTggS1x6CdhxnDjcUEVppZW4tGfLccYhlWMH25G6T8OrMu0uIHHgYHns-WY8_n9C3nL2gTPWfcyc11JWrGa42q6v5DOy47ITVS1V85zsmGC84m0tzsirnO8ZY71i7CU5E4KJTtZ8R37uzWpSzDaus6UmjDTFIRaMtwQFUly9yeVAtzyHicbgzYE6b1YaE52ScYU6jMp3oIsJZoIFQqHRUR8RX1N8mBfjH-FlHkcPp654lUuabcFj_kTjlig8rJBmCBaepsC0KTAdXpMXzvgMb077Obm7-nJ7eV3tv329ufy8ryx-pFS17YxUA2tHYDC0bpQdKKucknZ0AxgrlOodKqV6aZ20DXS8aw0qwpu27gdxTi6OfXHmHxvkopc5W_DeBIhb1nXT9D2SjUL0_T_oPX4g4HRI9QItaVWLVH2kLKqbEzi9JtQiHTRn-tE-fbRP41D6yT4tsejdqfU2LDD-KfntFwLiCGRMhQnS37f_0_YX3bapLQ</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Cheng, Sida</creator><creator>Fan, Shubo</creator><creator>Wang, Jie</creator><creator>Xiong, Shengwei</creator><creator>Li, Xinfei</creator><creator>Xu, Yangyang</creator><creator>Li, Zhihua</creator><creator>Guan, Hua</creator><creator>Zhang, Peng</creator><creator>Zhu, Hongjian</creator><creator>Huang, Chen</creator><creator>Zhang, Lei</creator><creator>Yang, Kunlin</creator><creator>Li, Xuesong</creator><creator>Zhou, Liqun</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1591-9581</orcidid></search><sort><creationdate>20210301</creationdate><title>Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy</title><author>Cheng, Sida ; Fan, Shubo ; Wang, Jie ; Xiong, Shengwei ; Li, Xinfei ; Xu, Yangyang ; Li, Zhihua ; Guan, Hua ; Zhang, Peng ; Zhu, Hongjian ; Huang, Chen ; Zhang, Lei ; Yang, Kunlin ; Li, Xuesong ; Zhou, Liqun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-2c7a58b06de0eb6fd57e8c8f85cdfbeac3889f020895cf5c4e7176a00014629b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Hospital costs</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mucosa</topic><topic>Nephrology</topic><topic>Robotics</topic><topic>Standardization</topic><topic>Stricture</topic><topic>Urology</topic><topic>Urology - Original Paper</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheng, Sida</creatorcontrib><creatorcontrib>Fan, Shubo</creatorcontrib><creatorcontrib>Wang, Jie</creatorcontrib><creatorcontrib>Xiong, Shengwei</creatorcontrib><creatorcontrib>Li, Xinfei</creatorcontrib><creatorcontrib>Xu, Yangyang</creatorcontrib><creatorcontrib>Li, Zhihua</creatorcontrib><creatorcontrib>Guan, Hua</creatorcontrib><creatorcontrib>Zhang, Peng</creatorcontrib><creatorcontrib>Zhu, Hongjian</creatorcontrib><creatorcontrib>Huang, Chen</creatorcontrib><creatorcontrib>Zhang, Lei</creatorcontrib><creatorcontrib>Yang, Kunlin</creatorcontrib><creatorcontrib>Li, Xuesong</creatorcontrib><creatorcontrib>Zhou, Liqun</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Sida</au><au>Fan, Shubo</au><au>Wang, Jie</au><au>Xiong, Shengwei</au><au>Li, Xinfei</au><au>Xu, Yangyang</au><au>Li, Zhihua</au><au>Guan, Hua</au><au>Zhang, Peng</au><au>Zhu, Hongjian</au><au>Huang, Chen</au><au>Zhang, Lei</au><au>Yang, Kunlin</au><au>Li, Xuesong</au><au>Zhou, Liqun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><addtitle>Int Urol Nephrol</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>53</volume><issue>3</issue><spage>479</spage><epage>488</epage><pages>479-488</pages><issn>0301-1623</issn><eissn>1573-2584</eissn><abstract>Purpose
To present our experience of laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures and summarize our treatment strategies for these challenging scenarios.
Methods
From March 2018 to January 2020, 53 patients with long proximal/middle ureteral strictures (2–6 cm) who underwent laparoscopic or robotic onlay flap/graft ureteroplasty were retrospectively enrolled. Different reconstruction techniques were chosen based on our management strategy: pelvic flap (PF) was the first choice for proximal stricture if pelvic tissue was sufficient for repair, while appendiceal flap (AF) was preferred over oral mucosa graft for both proximal and middle strictures.
Results
A total of 28 PFs, 9 AFs and 16 lingual mucosa grafts (LMGs) onlay ureteroplasty were performed successfully, with 33 laparoscopic procedures and 20 robotic procedures being undertaken. No intraoperative complications or conversion occurred. The median stricture length was 4 cm (range 2–6 cm). Compared with laparoscopic procedures, robotic procedures showed significantly shorter operative time (
P
= 0.008), shorter postoperative hospital stay (
P
= 0.011) but higher hospital cost (
P
< 0.001). At a mean follow-up of 12.8 months, the overall success rate was 94.3%. There was no difference in postoperative complications or the success rate between the approaches.
Conclusion
Laparoscopic and robotic onlay flap/graft ureteroplasty can be safe and feasible to repair long proximal/middle ureteral strictures while robotic procedures showed higher efficiency, faster recovery but higher cost. Our algorithmic strategies may provide beneficial references for their standardization and dissemination into clinical care.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>33037521</pmid><doi>10.1007/s11255-020-02679-5</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1591-9581</orcidid></addata></record> |
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source | SpringerLink Journals - AutoHoldings |
subjects | Hospital costs Laparoscopy Medicine Medicine & Public Health Mucosa Nephrology Robotics Standardization Stricture Urology Urology - Original Paper |
title | Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy |
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