BACKGROUND Minimally invasive treatment of long, multifocal ureteral strictures or failed pyeloplasty is challenging. Robot-assisted buccal mucosa graft ureteroplasty (RBU) is a technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. OBJECTIVE To evaluate outcomes for RBU in a multi-institutional cohort of patients treated for revision ureteropelvic junction obstruction and long or multifocal ureteral stricture at three tertiary referral centers. DESIGN, SETTING, AND PARTICIPANTS This retrospective study involved data for 19 patients treated with RBU at three high-volume centers between October 2013 and July 2016. SURGICAL PROCEDURE RBU was performed using either an onlay graft after incising the stricture or an augmented anastomotic repair in which the ureter was transected and re-anastomosed primarily on one side, and a graft was placed on the other side. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS The onlay technique was used for 79%, while repair was carried out using the augmented anastomotic technique for the remaining cases. The reconstruction was reinforced with omentum in 95% of cases. The ureteral stricture location was proximal in 74% and mid in 26% of cases. A prior failed ureteral reconstruction was present in 53% of patients. The median stricture length was 4.0cm (range 2.0-8.0), operative time was 200min (range 136-397), estimated blood loss was 95ml (range 25-420), and length of stay was 2 d (range 1-15). There were no intraoperative complications. At median follow-up of 26 mo, the overall success rate was 90%. CONCLUSIONS RBU is a feasible and effective technique for managing complex proximal and mid ureteral strictures. PATIENT SUMMARY We studied robotic surgery for long ureteral strictures using grafts at three referral centers. Our results demonstrate that robotic buccal mucosa graft ureteroplasty is a feasible and effective technique for ureteral reconstruction.

中文翻译：

---

使用口腔粘膜移植物的机器人输尿管重建：多机构经验。

背景技术长、多灶性输尿管狭窄或失败的肾盂成形术的微创治疗具有挑战性。机器人辅助颊黏膜移植输尿管成形术 (RBU) 是一种输尿管重建技术，可避免肠道插入或自体移植的发病率。目的 评估在三个三级转诊中心治疗输尿管盆腔交界处翻修和长或多灶性输尿管狭窄患者的多机构队列中 RBU 的结果。设计、设置和参与者 这项回顾性研究涉及 2013 年 10 月至 2016 年 7 月期间在三个高容量中心接受 RBU 治疗的 19 名患者的数据。手术过程 RBU 是在切开狭窄处后使用覆盖移植物或使用增强吻合修复术进行的，其中输尿管主要在一侧被横断并重新吻合，并且在另一侧放置移植物。结果测量和统计分析评估了术前、术中和术后变量和结果。进行了描述性统计分析。结果和局限性 79% 使用了高嵌技术，而其余病例使用增强吻合技术进行修复。95% 的病例用网膜加固重建。74% 的输尿管狭窄部位位于近端，26% 的病例位于中部。53% 的患者存在先前失败的输尿管重建。中位狭窄长度为 4.0cm（范围 2.0-8.0），手术时间为 200 分钟（范围 136-397），估计失血量为 95 毫升（范围 25-420），住院时间为 2 天（范围 1-15）。术中无并发症。中位随访 26 个月时，总体成功率为 90%。结论 RBU 是治疗复杂的近端和中段输尿管狭窄的可行且有效的技术。患者总结 我们在三个转诊中心研究了使用移植物治疗输尿管长狭窄的机器人手术。我们的研究结果表明，机器人颊黏膜移植输尿管成形术是一种可行且有效的输尿管重建技术。结论 RBU 是治疗复杂的近端和中段输尿管狭窄的可行且有效的技术。患者总结 我们在三个转诊中心研究了使用移植物治疗输尿管长狭窄的机器人手术。我们的研究结果表明，机器人颊黏膜移植输尿管成形术是一种可行且有效的输尿管重建技术。结论 RBU 是治疗复杂的近端和中段输尿管狭窄的可行且有效的技术。患者总结 我们在三个转诊中心研究了使用移植物治疗输尿管长狭窄的机器人手术。我们的研究结果表明，机器人颊黏膜移植输尿管成形术是一种可行且有效的输尿管重建技术。