Robot-assisted laparoscopic ureteral reimplantation with excisional tailoring for refluxing megaureter

Abstract

Objective: To demonstrate a novel technique for robot-assisted laparoscopic excisional tailoring and reimplantation of a refluxing megaureter.

Methods: A 9-year-old boy with dysfunctional elimination was found to have a refluxing megaureter and diminished ipsilateral renal function. Robotic ureteral reimplantation with excisional tailoring was performed using a three-port approach. Stay sutures were placed in the anterior aspect of the distal ureter and sequentially lifted to allow freehand excision of redundant ureter. The ureterovesical junction was left intact, and the ureter was repaired over a 6 Fr double-J stent. Detrusorotomy to create flaps for ureteral tunneling was performed with a carbon dioxide (CO2) laser.

Results: The patient's vesicoureteral reflux was successfully corrected, and he is now asymptomatic.

Conclusion: Specific technical modifications can facilitate robotic megaureter repair with intracorporeal excisional tailoring. The CO2 laser is advantageous for detrusorotomy.

Keywords: Laparoscopy; Megaureter; Robotics; Ureteral reimplantation; Vesicoureteral reflux.