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Robotic ureter reconstruction using the native ureter to treat long-segment ureteral stricture of the transplant kidney utilizing Indocyanine green: The first Korean experience

 Jinu Kim  ;  Seok Jeong Yang  ;  Deok Gie Kim  ;  Woong Kyu Han  ;  Joon Chae Na 
 INVESTIGATIVE AND CLINICAL UROLOGY, Vol.64(2) : 154-160, 2023-03 
Journal Title
Issue Date
Anastomotic Leak ; Constriction, Pathologic / etiology ; Constriction, Pathologic / surgery ; Female ; Fever ; Humans ; Indocyanine Green ; Kidney ; Middle Aged ; Republic of Korea ; Robotic Surgical Procedures* ; Ureter* / surgery
Kidney transplantation ; Robotic surgical procedures ; Ureter
Purpose: Ureteral strictures are a common complication after kidney transplantation. Open reconstruction is preferred for long-segment ureteral strictures that cannot be resolved endoscopically; however, it is known to have the potential to fail. We report 2 successful cases of robotic reconstruction surgery of a transplant ureter using the native ureter with the aid of intraoperative Indocyanine green (ICG).

Materials and Methods: Patients were placed in semi-lateral position. Using Da Vinci Xi, the transplant ureter was dissected, and the stricture site was identified. End-to-side anastomosis of the native ureter to the transplant ureter was performed. ICG was utilized to identify the course of the transplant ureter and confirm the vascularity of the native ureter.

Results: Case 1: A 55-year-old female underwent renal transplantation at another hospital. She had recurrent febrile urinary tract infections (UTIs) and a ureteral stricture requiring percutaneous nephrostomy (PCN). The PCN and ureteral stent were removed successfully after surgery. The patient had only 1 febrile UTI episode after surgery. Case 2: A 56-year-old female underwent renal transplantation at another hospital. She had acute pyelonephritis 1-month post-transplantation, and a long-segment ureteral stricture was identified. She developed a UTI with anastomosis site leakage in the early postoperative period, which resolved with conservative treatment. The PCN and ureteral stent were removed 6 weeks after surgery.

Conclusions: Robotic surgery for managing long-segment ureteral stricture after kidney transplantation is safe and feasible. The use of ICG during surgery to identify the ureter course and its viability can improve the success.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jinu(김진우)
Na, Joon Chae(나준채) ORCID logo https://orcid.org/0000-0003-4449-8472
Yang, Seok Jeong(양석정) ORCID logo https://orcid.org/0000-0001-6930-5978
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
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