Robotic management of complex ileal conduit complications.

内容摘要

Ileal conduit urinary diversion is associated with complications involving the uretero-ileal anastomosis, conduit segment, stoma, and abdominal wall. Complex complications may require individualized reconstructive strategies based on the specific anatomic failure mechanism. A video-based descriptive technical analysis was performed using a narrated operative recording of four robot-assisted reconstructive procedures for ileal conduit complications: right uretero-ileal stricture, bilateral uretero-ileal stricture, delayed conduit torsion with parastomal hernia, and crossed ureters after ileal conduit diversion. The unilateral stricture repair used antegrade methylene blue injection, needle confirmation of the ureteral lumen, ureteral incision and spatulation, ileal conduit incision, stenting, and running side-to-side uretero-ileal reimplantation. The bilateral stricture repair required mobilization and removal of the prior conduit, creation of a longer ileal conduit, bowel reconstruction, ICG-assisted ureteral identification, bilateral ureteral spatulation, stenting, and running uretero-ileal reimplantation. The torsion case involved circumferential stomal access, fascial opening, detorsion of a 360-degree conduit twist, and parastomal reinforcement with polypropylene mesh. The crossed-ureter revision used bilateral excision of prior anastomoses to healthy tissue, side-specific dye/saline confirmation, bilateral spatulation, double-barrel ureteral reconstruction, and circumferential anastomosis to the conduit. Complex ileal conduit revision can be organized around problem recognition, ureteral identity confirmation, preparation of healthy tissue, tension-aware reconstruction, and repair selection based on the underlying anatomic defect. This mechanism-based approach provides a structured framework for robot-assisted correction of uretero-ileal strictures, conduit torsion, and ureteral malorientation after ileal conduit diversion.