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Abstract

Introduction:

We aim to report our initial experience and describe the technique of robot-assisted excisional tapering and ureteral reimplantation using technical adaptations that are novel.

Materials and Methods:

Data of all patients who underwent robot-assisted excisional tapering with ureteral reimplantation at our center were reviewed. Patient characteristics, operative data, postoperative events, and follow-up outcomes were analyzed. All procedures were performed using the robotic da Vinci Si system in 30° Trendelenburg position. A standard five ports placement was used including three robotic 8 mm ports, a 12 mm camera port, and another 12 mm assistant port. Our operative technique, surgical tips, and tricks are discussed in the video.

Results:

Nine patients underwent ureteral reimplantation (seven obstructive and two refluxing megaureter). Median (interquartile range [IQR]) age of the patients was 36 (28–45.5) years. The male-to-female ratio was 2:1, and all patients had a left-sided megaureter. The mean operative time was 170 ± 44 minutes, with a mean blood loss of 78 ± 40 mL. Important steps such as identification of vas deferens in men, creation of detrusor tunnel, proper tapering with preservation of vascularity of the ureter, and creation of psoas hitch have been highlighted. The average duration of drain placement and hospital stay were 3.5 ± 1.3 and 5 ± 3 days, respectively. Two patients experienced postoperative fever. All patients had a bladder Foley catheter for 2 weeks and the Double-J stent was removed at 4 weeks. The average follow-up period was 58 ± 29 weeks. On follow-up, pain resolved in eight patients, and none experienced urinary tract infections. One patient reported persistent vague pain.