Robotic Bilateral Ileal Interposition: The Total Intracorporeal Approach

Area of Science:

• Urology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Upper ureteric strictures can be managed with grafting, but complex cases with long or bilateral strictures often require ileal interposition.
• Ketamine-associated uropathy can present with symptoms mimicking retroperitoneal fibrosis, leading to long, bilateral ureteric strictures.

Purpose of the Study:

• To present a total intracorporeal robotic technique for bilateral ileal interposition using a U-configured small bowel loop.
• To demonstrate the feasibility and safety of this minimally invasive approach for complex ureteric strictures.

Main Methods:

• A 34-year-old female patient with bilateral long ureteric strictures due to ketamine-associated uropathy underwent robotic reconstruction.
• The procedure involved retroperitoneal access, exposure of bilateral ureters, and side-to-end anastomosis of a U-configured small bowel loop to the ureters and bladder.

Main Results:

• The surgery was completed in 507 minutes with an 8-day hospital stay.
• Postoperative imaging (DTPA scan, IVU, CT scan) confirmed unobstructed drainage at multiple follow-up intervals.
• Renal function remained stable over 3 years, and the patient was symptom-free.

Conclusions:

• Retro-caecal exposure provides convenient access to the ureters for complex reconstructive surgery.
• Robotic bilateral ileal interposition is a safe and effective minimally invasive technique for managing long or bilateral ureteric strictures.