Robotic-assisted laparoscopic ureteral reimplantation using the LUAA technique: VCUG-confirmed outcomes, learning...

To delineate the learning curve of robotic-assisted laparoscopic ureteral reimplantation (RALUR) through the LUAA extravesical technique, we characterized efficacy and safety outcomes throughout surgical proficiency development using cumulative sum (CUSUM) analysis and perioperative trifecta outcomes. RALUR is the minimally invasive alternative to open reimplantation for paediatric vesicoureteral reflux (VUR); however, its learning curve remains poorly defined due to small series and inconsistent outcome reporting.

We performed a retrospective single-surgeon study of 125 patients undergoing RALUR for primary VUR divided into pre-LUAA (2008-2011), evolving LUAA (2011-2014) and standardized LUAA (2014-2025) phases. The primary outcome was radiographic VUR resolution on postoperative voiding cystourethrogram. Secondary outcomes included urinary retention and 90-day Clavien-Dindo grade ≥3 (CDG3+) complications. CUSUM analysis of operative time defined competency, proficiency and mastery.

VUR resolution improved from 76% (pre-LUAA) to 85.2% (evolving) and 94.4% (standardized) with an overall success rate of 87.2%. Urinary retention (4%) and CDG3+ complications (3.2%) remained low. CUSUM analysis demonstrated competency at case 28 and mastery at case 99 overall. Limitations include retrospective design, single-surgeon experience and lack of comparison with open surgery.

This largest single-surgeon study with objective VCUG-based outcomes demonstrates that the LUAA technique achieves high radiographic success with low complication rates. Surgical proficiency is safely attained within a modest case volume for unilateral as well as bilateral cases. These findings provide a quantitative framework to guide training and credentialing in RALUR.