Robotic-assisted laparoscopic ureteroplasty using a non-transecting side-to-side technique for distal ureteral strictures

Abstract

ObjectiveTo report our initial experience with robotic-assisted laparoscopic (RAL) ureteroplasty using a non-transecting side-to-side anastomosis to manage distal ureteral strictures and demonstrate our surgical technique. Patients and surgical procedureWe retrospectively reviewed patients who underwent RAL ureteroplasty using a non-transecting side-to-side anastomosis between 2020 and 2023. The primary outcome measure was clinical success, defined as freedom from additional surgical intervention for ureteral stricture recurrence at the last follow-up. The secondary outcome measure was radiologic success, defined as lack of evidence of hydronephrosis on post-operative renal ultrasound (RUS). The video highlights the steps to our surgical technique: 1) set up, 2) ureteral identification and dissection, 3) bladder mobilization, 4) ureterotomy and cystotomy, and 5) anastomosis. ResultsNine patients were included in our study, with 78% female (n=7) and a median age of 50 years (IQR 45-66). The median stricture length repaired was 4 cm (IQR 2-8). The etiology of stricture disease included iatrogenic, radiation, endometriosis, and idiopathic. The median operative time and estimated blood loss were 228 min (IQR 211-333) and 50 mL (IQR 40-75). There were no intraoperative complications. Post-operatively, one patient had a Clavien-Dindo grade ≥3 complication due to stent displacement on postoperative day one, which was repositioned endoscopically the same day. The median length of stay was 2 days (IQR 2-3), and the median follow-up time was 4 months (IQR 1-13). 100% (n=9) of patients met our clinical and radiologic success definition. ConclusionsRAL ureteroplasty via a non-transecting side-to-side anastomosis is a safe and effective treatment option for distal ureteral strictures.