Introduction: Vascular injuries are serious complications of robotic-assisted approaches. Surgeons must be capable of managing these complications. Recorded videos can be used for teaching purposes. Here we report on a case of left common iliac injury during robotic ureteroneobladder reimplant that required robotic repair.
Methods: Patient is a 49-year-old male with history of bladder cancer who underwent robotic cystoprostatectomy with neobladder urinary diversion complicated by left ureteroneobladder anastomotic stricture. Ureter was heavily adhered to common iliac vein and an injury to left common iliac vein was sustained during ureterolysis. Primary repair with interrupted suture was attempted and failed. Then, proximal and distal control was obtained and a bovine pericardial patch was used in tubular manner to reconstruct the anterior wall of the common iliac vein. Rest of surgery was carried to completion without any other complications.
Results: Patient required 2 units of packed red blood cells intraoperatively. Inferior Vena Cava filter was placed by interventional radiologist on post-operative day 1 and anticoagulation was started with heparin drip and later transitioned to Apixaban for 3 months. No signs of lower extremity edema or venous insufficiency was noted post- operatively. He had otherwise an uncomplicated post-operative course and was discharged home on post-operative day 9.
Conclusions: Vascular injury during robotic surgeries is a serious complication. There are variety of techniques and tools that can assist in successful repair. Surgeons should be familiar and comfortable with managing these vascular injuries properly. Recorded videos can play a useful role for teaching purposes.