Robotic “Reverse-Seven” Ureteroileal Reimplantation: Step-by-Step Surgical Technique

Abstract

Introduction:

Ileoureteral replacements are complex surgeries performed when the length or location of the ureteral injury precludes primary ureteroureterostomy, Boari flap, or psoas hitch reconstruction. Bilateral ureteroileal reimplant adds even more complexity to this procedure. ¹ Our objective is to present a step-by-step technique to effectively perform a bilateral ureteroileal reimplantation in a reverse-seven configuration.

Materials and Methods:

A 51-year-old female with history of rectal adenocarcinoma treated with neoadjuvant chemoradiation and surgery presented with bilateral distal ureteral strictures managed with bilateral percutaneous nephrostomy tubes. At diagnosis, renal mercaptuacetyltriglycine scan showed 73% and 27% for the left and right kidney, respectively. The first step is identification of both ureters at the pelvic brim. Then, the ureters are incised longitudinally along the anterolateral surface. A cystotomy is performed at the bladder dome. Ileal segment is harvested after adequate measurement of the distance needed for the repair, and oriented in an isoperistaltic manner. The left and right ureters are then anastomosed to the proximal end of the harvested ileum. Finally, ileovesical anastomosis was carried out.

Results:

The operative time was 5.25 hours, and the estimated blood loss was 50 mL. The postoperative course was uneventful, and discharge occurred on postoperative day (POD) 5. Jackson–Pratt drain was removed on POD 13, and the ureteral Double-J stents were removed on POD 20. Serum creatinine 9-month postoperatively was 2.37 mg/dL, from 2.43 mg/dL preoperatively. Baseline glomerular filtration rate increased from 14 to 23 mL/(min·1.73 m²). At 11-month follow-up, no complications were reported.

Conclusions:

Robotic ureteroileal reimplantation in a reverse-seven configuration is a safe and effective technique for the management of bilateral ureteral injury at experienced centers.

Patient Consent:

Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

Music:

www.adamvitovsky.com—Stratosphere (Royalty free).

No competing financial interests exist

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Runtime of video: 7 mins 37 secs