Application of robot-assisted laparoscopy combined with indocyanine green fluorescence imaging in the repair and reconstruction of complex ureteral stenosis
Objective To evaluate the efficacy and safety of robot-assisted laparoscopy combined with indocyanine green fluorescence imaging in the treatment of complex ureteral strictures.Methods A total of 13 patients with complex ureteral strictures who were admitted to the Affiliated Hospital of Xuzhou Medical University from December 2022 to October 2023 were enrolled and their clinical data were retrospectively analyzed.All patients developed iatrogenic ureteral strictures following endoscopic surgery for stones or recurrent strictures after previous ureteral stricture surgeries.All cases were approached transabdominally,with indocyanine green solution injected into the affected ureter intraoperatively through a nephrostomy tube,ureteral stent,or intravenous route.The color fluorescence mode was used to assist in identifying the stenotic segment of the ureter.Six patients underwent robot-assisted laparoscopic ureteral stricture resection with end-to-end anastomosis,three patients underwent robot-assisted laparoscopic ureteral reimplantation,two patients underwent robot-assisted laparoscopic ureteral reconstruction with a bladder muscle flap,one patient underwent robot-assisted laparoscopic ureteroplasty using buccal mucosa,and one patient underwent robot-assisted laparoscopic ureteral repair with an appendiceal patch.Results All 13 surgeries were successfully completed without intraoperative or postoperative complications,and no conversion to open surgery was necessary.The use of fluorescence imaging during surgery demonstrated good blood supply at the stenotic segments and anastomotic sites.The average operative time was 163(110-285)min,with an average intraoperative blood loss of 40(20-110)mL.Follow-up ranged from 3 to 12 months,during which abdominal CT,intravenous pyelography,and urinary system ultrasound showed significant improvement in hydronephrosis in all patients,with no recurrence of strictures.Conclusions Robot-assisted laparoscopic treatment of complex ureteral strictures is safe and effective.Indocyanine green fluorescence imaging technology helps accurately locate the ureteral stricture segment and assess blood supply,thereby effectively shortening operative time.This technique is simple,safe,and worthy of promotion.
万方数据
维普
