Complex Robotic Lower Urinary Tract Surgery in Patients with History of Open Surgery

Purpose: We describe our experience with robot-assisted complex lower urinary tract reconstruction in patients with a history of open abdominal surgery. Materials and Methods: Patients with any previous open abdominal surgery undergoing robot-assisted complex lower urinary tract reconstruction were included. Complex lower urinary tract reconstruction was defined as bladder neck reconstruction or continent catheterizable conduits or both, redo surgery at the bladder neck for persistent incontinence or any of these procedures with creation of a Malone antegrade continence enema. Ureteral and renal surgeries were excluded. Patient demographics, surgery performed, operative techniques, operative times and outcomes were assessed. Results: A total of 36 patients met inclusion criteria, of whom 21 had undergone multiple laparotomies for ventriculoperitoneal shunt revision, 14 had undergone laparotomy with other adjunct procedures and 1 had undergone laparotomy with colostomy. No access injury occurred and there were 5 conversions. Mean operative time was 8.2 hours (range 4 to 12) and mean length of hospital stay was 74.9 hours (23 to 216). The first 18 cases took longer than the last 18 cases (mean 9.1 vs 7.5 hours, p = 0.002). Patients with multiple ventriculoperitoneal shunt revisions had higher conversion rates (p = 0.01) and longer mean operative times (p = 0.002). Patients with a history of multiple ventriculoperitoneal shunt revisions also had longer hospital stays (p = 0.02). Conclusions: Robot-assisted complex lower urinary tract reconstruction in patients with previous open abdominal surgery is safe and feasible. Longer operative times should be expected early in the experience of a surgeon. Patients with multiple prior ventriculoperitoneal shunt revisions had higher conversion rates and longer operative times compared to those with other indications for prior surgery.