Presented by: Stephanie Banks Medical Student
Northwell Health Institute

Introduction

Minimally invasive (MIS) techniques have become the mainstay of numerous urologic procedures given the potential for decreased morbidity compared to open. In this series, we compared outcomes of laparoscopic (LAP), robotic (RA), and open ureteral reimplantation (UR) techniques in a large cohort. 

Materials

All MIS (LAP or RA) and open UR cases at our institution between 2014 and 2021 were identified. Data collected included baseline, pathologic, perioperative, and postoperative features. Chi-squared and ANOVA with post hoc Tukey analysis were performed for all categorical and continuous variables, respectively.

Results

,

A total of 322 patients underwent UR, including 95 (29.5%) open, 124 (38.5%) LAP, and 103 (32.0%) RA. Groups were similar in terms of race, number of previous abdominal surgeries, and laterality of the operation (Table 1). Patients in the LAP group were found to be significantly younger (p<0.001), had higher BMIs (p=0.02), were more likely to be female (p=0.035), and had higher American Society of Anesthesiologists (ASA) scores (p=0.0003) than both the open and RA groups. Malignancy as the indication for surgery was more common in the LAP group than in the open group (p=0.014). Operative time was significantly shorter for the LAP group (240.0 min) compared to the open group (263.5 min) (p=0.031). Estimated blood loss (EBL) was significantly higher in the open group (200 ml) compared to both the LAP (150 ml) and RA groups (100 ml) (p=0.0003). Rates of conversion to open technique were comparable in both LAP (4, 4.9%) and RA (1, 1.0%) groups. Length of stay (LOS) was significantly longer in the open group (6 days) compared to both the LAP (3 days) and RA group (2 days) (p<0.0001). On post hoc analysis, the open group had significantly more complications (14, 14.4%) than both RA (7, 6.8%) and LAP (4, 3.2%) (p=0.005) groups. There were no significant differences between groups regarding postop treatment failures or 90-day readmission rates.

Conclusion

While both MIS and open UR approaches are feasible and effective, MIS offers lower EBL, shorter LOS, and decreased complications.

Funding

None.

Lead Authors

Sarah Razavi, MD
Northwell Health Institute

Alexa R. Meyer, MD
Northwell Health Institute

Co-Authors

Aaron Zhang, MD
Northwell Health Institute

Aleem Khan, MD
Northwell Health Institute

Louis R. Kavoussi, MD, MBA
Northwell Health Institute

Lee Richstone, MD, FACS, FRCS
Northwell Health Institute