Management of Missed Ureteric Injury: A Case Report of Robotic Surgery

What is it about?

The management of delayed diagnosis of ureteric injury is complex and challenging, with wide variability in its clinical presentation. A combination of a multidisciplinary approach, selective use of minimally invasive surgery (MIS), and adjunct surgical techniques can achieve optimal outcomes for reconstructive surgery. The diagnosis of ureteric injury is often made postoperatively and may be challenging due to non-specific symptoms. The immediate goals of care include restoration of urinary drainage, control of further extravasation, drainage of existing collections, and prevention of infection. The timing of reconstructive surgery can be debated, but early repair may be attempted within 72 hours before dense adhesions form. The use of indocyanine green (ICG) can help identify the site of ureteric injury in robotic surgeries. The approach of surgery should consider the patient's history of previous abdominal surgery and the relative contraindications for MIS. Reconstructive options depend on the site and extent of the injury, and the choice of reconstruction should be based on the individual case. A multidisciplinary approach is essential for successful outcomes in managing ureteric injury.

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Why is it important?

This research is important as it highlights the complexity and challenges of managing delayed diagnosis of ureteric injury, which can result in poor outcomes. The article presents a case of a patient who had a missed ureteric injury following an emergency Hartmann's procedure and discusses the multidisciplinary approach, selective use of minimally invasive surgery, and adjunct surgical techniques that can achieve optimal outcomes for reconstructive surgery. The research emphasizes the importance of early diagnosis and prompt intervention to mitigate the myriad of complications that can arise from urinary leaks. Key Takeaways: 1. Delayed diagnosis of ureteric injury can have wide variability in its clinical presentation and can be challenging to manage. 2. A multidisciplinary approach, selective use of minimally invasive surgery, and adjunct surgical techniques can achieve optimal outcomes for reconstructive surgery. 3. Early diagnosis and prompt intervention are crucial in mitigating complications from urinary leaks.