Robot-assisted Foley Tie Ureteric Tapering and Reimplantation

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Vesicoureteric reflux (VUR) is a common condition in children.
• Intravesical ureteral tapering can be challenging in pediatric robotic-assisted ureteric reimplantation.
• A novel technique is needed to address these challenges.

Purpose of the Study:

• To introduce and evaluate the feasibility and outcomes of robot-assisted Foley tie ureteric tapering (RAFUT) and reimplantation.
• To assess RAFUT's effectiveness in pediatric patients with primary VUR.
• To determine the safety and efficacy of this novel surgical approach.

Main Methods:

• Retrospective analysis of pediatric patients with primary VUR undergoing RAFUT (January 2019 - July 2021).
• Detailed review of preoperative characteristics, operative details, and postoperative outcomes.
• Specific techniques included meticulous patient positioning, precise port placement (6 mm separation), bladder anchoring, and Foley tie ureteric tapering.

Main Results:

• Successful intravesical RAFUT in all four pediatric patients.
• No intraoperative or postoperative complications observed.
• Resolution of VUR on postoperative imaging, with no recurrent UTIs during follow-up (1.5-4 years).
• Operative times ranged from 180-210 min; estimated blood loss was 35-50 mL.

Conclusions:

• RAFUT is a safe and effective surgical technique for intravesical ureteral tapering in pediatric robotic-assisted ureteric reimplantation.
• This innovative approach overcomes challenges in intravesical surgery for dilated ureters.
• RAFUT offers precise excision and suturing, maintaining anatomical orientation.