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dc.contributor.authorBrandao, Luis Felipe [UNIFESP]
dc.contributor.authorLaydner, Humberto
dc.contributor.authorAkca, Oktay
dc.contributor.authorAutorino, Riccardo
dc.contributor.authorZargar, Homayoun
dc.contributor.authorDe, Shubha
dc.contributor.authorKrishnam, Jayram
dc.contributor.authorPallavi, Patil
dc.contributor.authorMonga, Manoj
dc.contributor.authorStein, Robert J.
dc.contributor.authorMagi-Galluzzi, Cristina
dc.contributor.authorAndreoni, Cassio [UNIFESP]
dc.contributor.authorKaouk, Jihad H.
dc.identifier.citationWorld Journal Of Urology. New York, v. 35, n. 1, p. 89-96, 2017.
dc.description.abstractTo evaluate the feasibility and functional outcomes in porcine models of a novel robotic surgical technique for the treatment of complex ureteral injuries and strictures. Six pigs underwent robotic ureteral reconstruction using a long tabularized peritoneal flap and followed for 6-9 weeks after the surgery. Ureteral flap vascularity, intra-renal pressure, patency of the conduct, endoscopic aspect of the flap, renal function and histopathology were evaluated. All animals successfully underwent ureteral reconstruction using a tubularized peritoneal flap. Median operative time was 223 min (162-360). Flap tubularization suture took 31 min (19-47), and proximal anastomosis took 20 min (15-38). Bladder mobilization with psoas hitch and distal anastomosis took 9 min (7-12) and 23 min (13-46), respectively. On follow-up, significant shrinkage of the ureteral flap in both length and width was observed. Antegrade pyelograms confirmed dilation and tortuosity of the proximal ureter, dilation of the renal pelvis, and major and minor calyxes without any definitive strictures. Microscopically, focal urothelial lining was seen in the neoureter. Creatinine level was significantly higher at the end of the follow-up period (p = 0.003). Robot-assisted ureteral reconstruction using a tubularized peritoneum flap is technically feasible and reproducible. The flap sustained abundant vascular supply after different intervals of follow-up and the peritoneal mesenchymal cells differentiated into urothelium and myofibroblasts. Further studies are needed to address the issue of functional obstruction to improve long-term renal function outcomes.en
dc.description.sponsorshipUrology department and Research Program Committee from Cleveland Clinic
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipSchool of medicine of Federal University of Sao Paulo (EPM-UNIFESP, Brazil)
dc.relation.ispartofWorld Journal Of Urology
dc.rightsAcesso restrito
dc.subjectUreter reconstructionen
dc.subjectRobotic surgeryen
dc.subjectTubularized peritoneal flapen
dc.subjectReconstructive surgeryen
dc.subjectMinimally invasive surgeryen
dc.subjectTissue engineeringen
dc.subjectStem cellsen
dc.titleRobot-assisted ureteral reconstruction using a tubularized peritoneal flap: a novel technique in a chronic porcine modelen
dc.description.affiliationCleveland Clin, Glickman Urol & Kidney Inst, 9500 Euclid Ave,Q10-1, Cleveland, OH 44195 USA
dc.description.affiliationCleveland Clin, Dept Pathol, Cleveland, OH 44106 USA
dc.description.affiliationUniv Fed Sao Paulo, Dept Urol, Paulista Sch Med, Sao Paulo, SP, Brazil
dc.description.affiliationCase Western Reserve Univ, Sch Med, Cleveland, OH USA
dc.description.affiliationUnifespDepartment of Urology, Paulista School of Medicine, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.coverageNew York

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