Ziho Lee Archives

Ziho Lee

Reconstruction of Complex Upper and Mid Ureteral Strictures with Buccal Mucosa Graft Ureteroplasty

Posted by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, focuses on using buccal mucosa grafts in ureteral reconstruction and highlights their value in complex cases. Buccal mucosa grafts offer a practical alternative when standard resection and anastomosis are not feasible.

In this 11-minute presentation, Dr. Lee describes onlay grafts, where the anterior surface of the ureter is slit and patched with the graft, and augmented anastomotic repairs for more severe cases with obliterated segments. He shares a short video of both techniques.
Dr. Lee emphasizes the importance of minimizing tissue manipulation and dissection, particularly in cases with fibrosis. Strategies like measuring defects with precision and securing grafts using Monocryl sutures are discussed for graft placement. He recommends using omental wrapping or attaching grafts to the psoas muscle to ensure stability and promote vascularization, especially in retroperitoneal cases.

Tips and Tricks for Robotic Ileal Ureter

Posted by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, provides insights into robotic ileal ureter reconstruction, offering practical strategies for optimizing outcomes.

In this 10-minute presentation, Dr. Lee uses photos and procedure videos to outline an effective surgical strategy, starting with proximal ureter dissection to assess feasibility, followed by bowel harvest, bladder preparation, and distal anastomosis. Proper exposure is stressed as critical to ensure the best outcomes. Port placement strategies are discussed, including single setup configurations and rotating the robotic boom for upper tract access. Various tunneling techniques are detailed, including creating a mesenteric window to reduce strain and ensure smooth passage of the ileal segment.
The presentation concludes by emphasizing the importance of meticulous technique and thorough planning, especially for patients with complex histories, including prior pelvic radiation. While the indications for ileal ureter replacement are decreasing, it remains a vital tool for urologists. With careful patient selection and precise execution, surgical success rates can reach 90%, minimizing the need for future interventions.