Robot-assisted ureteral reconstruction combined with trans-trocar flexible ureteroscopy using a flexible and
Chaoyue Ji1, Jianxing Li1, Weiguo Hu1
1Department of Urology, Beijing Tsinghua Changgung Hospital School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, 168 Litang Road, Changping District, Beijing, 102218, China.
Background:
Simultaneous management of upper urinary tract stricture and renal calculi remains a technical challenge in minimally invasive urology. Conventional hybrid techniques combining robotic reconstruction with standard flexible ureteroscopy often face limitations such as impaired visualization, irrigation fluid leakage, and difficulty in managing a substantial stone burden. We report a refined hybrid technique that integrates a flexible and navigable suction ureteral access sheath (FANS) directly into the robot-assisted ureteral reconstructive workflow.
Case Presentation:
A 49-year-old male patient presenting with a 1-cm middle-to-upper ureteral stricture and a concomitant lower-calyceal stone cluster (aggregate size: 18 × 16 × 12 mm; approximal density: 550 HU) underwent a refined hybrid procedure using the da Vinci Xi system following failed retrograde intrarenal surgery. Intraoperatively, a 12/14 Fr FANS (40 cm) was introduced through an assistant trocar and utilized for 40 min to facilitate thulium fiber laser lithotripsy (1.2 J/10 Hz; active lasing time: 15 min), enabling direct fragment evacuation. Stone-free status was initially confirmed via kidney-ureter-bladder radiography on postoperative day 2. At the 14-month follow-up, abdominal CT demonstrated significant resolution of hydronephrosis and confirmed no recurrence of stones or ureteral obstruction.
Conclusions:
The trans-trocar FANS-assisted hybrid approach is a feasible and efficient single-session strategy for complex upper urinary tract pathology. The core innovation lies in the functional integration of suction-assisted endourology into robotic reconstructive surgery.
