Extracorporeal ureteral tailoring during HIDES laparoscopic robotic-assisted ureteral reimplantation for megaureter

Although laparoscopic robotic-assisted intracorporeal ureteral tailoring is feasible and several authors have reported doing it, it adds a level of complexity to the surgery that many robotic surgeons are uncomfortable with. Also, some techniques for tailoring the ureter, like the one described by Ossandon, would be very difficult to perform intracorporeally or violate principles of hidden incision endoscopic surgery (HIDES) by adding extra ports in visible locations.

Extracorporeal ureteral tapering is performed by extracting the ureter through a 10-mm step trocar placed in the midline at the level of the biking line. Once the ureter is tapered and a stent has been secured, the 10-mm trocar is replaced and the rest of the reimplant is performed in a way very similar to when performing a robotic apendicovesicostomy.

Extracorporeal ureteral tailoring can be added to the bag of tricks that robotic surgeons can resort to when faced with the situation of a dilated ureter without compromising cosmesis.