Robot-assisted uretero-ureterostomy.

Abstract

Introduction: Robotic uretero-ureterostomy (RUU) is a minimally invasive surgical technique that has gained popularity in recent years, especially for the treatment of duplex systems, as an alternative to ureteral reimplantation.

Aims of the study: Focusing on technical considerations and supporting its use, we aim to describe our procedure and results in children.

Materials and methods: From November 2018 to December 2023, we collected data on RUU performed by Da Vinci Surgical Robot Xi® in pediatric patients at our center. All patients underwent preoperative ultrasound, functional studies, and cystourethrography. Surgery was indicated for duplex systems with ectopic upper ureter. The orthotopic ureter was stented during preoperative cystoscopy. Three or four trocars were placed along the transverse umbilical line with the patient in 20° Trendelenburg position. The ectopic ureter was isolated below the iliac vessels, transected distally and anastomosed end-to-side to the stented ureter.

Results: Eight robotic UU (7 females, 1 males) were performed. Median age and weight were 4.4 years (0,6-12,2) and 15,8 kg (8.5-62) respectively. Median operative time was 129,5 min (108-275) and median console time 66 min (36-175). Four robotic arms were used in 6 patients and 3 in the remaining two. Median distance between trocars was 4.8 cm (4-5). All patients maintained the stent for a median time of 45,5 days (37-67). No intraoperative complications nor conversion were reported. Median hospital stay was 3 days (2-9) and median follow-up 7 months (3.2-29). All patients reported a successful procedure as assessed clinically by resolution of urinary incontinence and ultrasonographically by reduced or resolved urinary dilatation.

Conclusions: RUU can be safely performed in pediatric patients, including low-weight ones. It has acceptable operative times, short hospital stays and optimal success rates with no intraoperative complications. RUU is a feasible and safe alternative technique to duplex systems, resolving symptoms and obstruction and avoiding major bladder surgery.