Robotic-assisted Laparoscopic Ureterocalicostomy (RALUC): How we do it

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Ureterocalicostomy involves connecting lower calyces to the ureter after removing a hydronephrotic lower renal pole.
• Indications include failed pyeloplasty, ureteropelvic junction obstruction (UPJO) with anatomical variations (e.g., intrarenal pelvis), and proximal ureteral strictures.

Purpose of the Study:

• To demonstrate the technique of Robotic-Assisted Laparoscopic Ureterocalicostomy (RALUC).
• To showcase its application in a patient with UPJO and an intrarenal pelvis.

Main Methods:

• A transperitoneal approach with the Hassan technique and four DaVinci® trocars was employed.
• Key steps included retroperitoneal dissection, proximal ureter mobilization, selective bulldogging of the lower pole artery, and resection of the lower renal pole for caliceal access.
• The Garland suture technique was used for hemostasis, followed by spatulation and suturing of the ureter to the lower calix using a single-knot technique.

Main Results:

• The procedure had a total operative time of 114 minutes with an estimated blood loss of 25 mL.
• Postoperative follow-up showed no hydronephrosis after JJ catheter removal at 40 days.
• The patient remained asymptomatic with normal renal function (creatinine 92 µmol/L, GFR 70 ml/min) and mild caliceal dilatation.

Conclusions:

• RALUC is an effective and repeatable technique for UPJO reconstruction, particularly in cases with narrow or intrarenal pelves.
• This robotic approach is a feasible, safe, and efficient option for selected patients needing upper urinary tract reconstruction.