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A 64-year-old woman, who experienced chronic flank soreness, sought for medical attention until she could not tolerate it anymore. Surprising to her, the problem was due to long-term ureteral stones complicating renal edema, and ureteral stenosis. After receiving Double-J ureteral stent placement, she developed hematuria and infection. She was then referred to Wanfang Hospital where she received ureteral reconstruction using the Da Vinci robotic arm surgery and resumed her normal life.
Dr. Yu-Ching Wen, Director of Urology Department, said that the woman’s image study showed renal and ureteral stones obstructing the urine flow with consequent hydronephrosis (swollen kidney). Her ureter became narrowed due to long term inflammation. The double J catheter stimulated her bladder, leading to frequent and small amount urination as well as uncomfortable foreign body sensation. In addition, the hematuria happened because of secondary infection. She was advised to undertake ureteral reconstruction using the Da Vinci robotic arm surgery. She resumed health and remained uneventful up to now.
Dr. Wen said that double J ureteral stent placement is just a conservative and symptom relief treatment for ureteral stricture. It is not a fundamental solution. The catheter shall be replaced every 3 to 6 months to avoid secondary infection, and majority of patients will be dependent on continuous use.
Surgical resection of the narrowed ureter segment with re-connection of the intact ends is the best treatment. However, traditional laparotomy surgery creates big wound and often requires a hospital stay of longer than 7 days. Alternative laparoscopic surgery is subject to anastomosis site leakage because re-connection of the cut ends is a pretty subtle technique due to the small caliber of the ureter.
Dr. Wen further explained that Da Vinci robotic arm system is equipped with a high-resolution 3D magnification optical device, mechanical arms mimicking the human wrist, and sophisticated controllers. Therefore, precise dissection and re-anastomosis can be assured and can minimize surgical bleeding or complications. Patients can also recover in a short time and get much better outcome.
The Da Vinci robotic arm surgery system was introduced into the Wanfang Hospital in late December 2017. It has already benefited more than 100 cases, and is applied not only for better cancer removal to reduce recurrence but also for other surgeries such as repair of ureteral stenosis, urinary incontinence, uterine or rectal prolapse, cardiac valve disease etc. It does offer a very precise and minimally invasive surgical option for patients.