Single-port robotic ileal ureter reconstruction: feasibility, technique, and early outcomes

Ileal ureter interposition is a well-established option for complex ureteral strictures. While minimally invasive approaches have evolved, the application of the single-port (SP) robotic platform for ileal ureter reconstruction has not been previously reported. This study presents the first clinical series evaluating the feasibility, technique, and early outcomes of SP robotic ileal ureter reconstruction.

We retrospectively reviewed a prospectively maintained database of patients who underwent SP robotic ileal ureter substitution between September 2019 and November 2024 by a single surgeon. Demographic, perioperative, and functional data were analyzed. Surgical success was defined as freedom from reintervention, absence of radiographic obstruction, and stable renal function. Pre- and postoperative renal function was compared using paired statistical analysis.

Seventeen patients underwent SP robotic ileal ureter reconstruction (29% male), with a mean age of 54 years. Radiation-induced strictures accounted for 70.6% of cases. Unilateral reconstruction was performed in 8 (47.1%), while 8 (47.1) required bilateral reconstruction with V-shaped or reverse-7 configurations, including bladder augmentation in selected cases. One patient (5.9%) underwent unilateral ileal ureter with bladder neck reconstruction. The median ileal segment length was 25 cm. Mean operative time was 308 min, and median blood loss was 70 mL. One intraoperative complication (5.9%) occurred. Postoperative complications were observed in 47%, with 11.8% classified as Clavien-Dindo grade IIIa. Renal function remained stable (preoperative eGFR 56.4 vs. postoperative 57.5 mL/min/1.73 m², p = 0.803). At a median follow-up of 20.5 months, the overall success rate was 94.1%.

Single-port robotic ileal ureter reconstruction is a feasible and effective technique for complex ureteral strictures, achieving high early success with acceptable morbidity.