Robot-assisted uretero-ureterostomy

Area of Science:

• Urology
• Pediatric Surgery
• Minimally Invasive Surgery

Background:

• Robotic uretero-ureterostomy (RUU) is an increasingly popular minimally invasive surgical technique.
• It serves as an alternative to ureteral reimplantation for treating pediatric duplex systems.

Purpose of the Study:

• To describe the technical considerations and outcomes of RUU in pediatric patients.
• To support the use of RUU as a viable surgical option.

Main Methods:

• Data collected from November 2018 to December 2023 for pediatric RUU using the Da Vinci Surgical Robot Xi®.
• Preoperative imaging and functional studies were performed; surgery indicated for duplex systems with ectopic upper ureter.
• Standardized surgical technique involving trocar placement, ureteral isolation, transection, and end-to-side anastomosis to a stented orthotopic ureter.

Main Results:

• Eight pediatric RUU procedures were performed, with no intraoperative complications or conversions.
• Median operative time was 129.5 minutes, console time 66 minutes, and hospital stay 3 days.
• Successful outcomes were observed, with resolution of urinary incontinence and improvement in urinary dilatation.

Conclusions:

• Robotic uretero-ureterostomy is a safe and feasible procedure in pediatric patients, including those with low weight.
• The technique demonstrates acceptable operative times, short hospital stays, and high success rates.
• RUU effectively resolves symptoms and obstruction in duplex systems, avoiding more extensive bladder surgery.