Robot-assisted Foley Tie Ureteric Tapering and Reimplantation

Abstract

Objective: This study aimed to introduce and evaluate the feasibility and outcomes of a novel surgical technique, robot-assisted Foley tie ureteric tapering (RAFUT) and reimplantation, specifically designed for intravesical ureteral tapering during pediatric robotic-assisted ureteric reimplantation.

Materials and methods: A retrospective analysis was conducted on pediatric patients diagnosed with primary vesicoureteric reflux (VUR), who underwent RAFUT between January 2019 and July 2021. Patient records were reviewed to assess preoperative characteristics, operative details, and postoperative outcomes. RAFUT involved meticulous patient positioning, precise port placement with a 6 mm separation, and bladder anchoring to maintain pneumovesicum. Ureteric tapering was performed with the Foley tie technique to enhance surgical precision. The primary outcome measures included operative time, complications, and postoperative VUR resolution.

Results: All four patients underwent successful intravesical RAFUT without any intraoperative or postoperative complications. The age of the patients ranged from 3 to 12 years, with varying bladder capacities (range: 210-550 mL). The operating times ranged from 180 to 210 min, and the estimated blood loss was 35-50 mL. None of the patients required conversion to open surgery. Patients demonstrated resolution of VUR on postoperative imaging, and none experienced recurrent urinary tract infections during follow-up, which ranged from 1.5 to nearly 4 years.

Conclusion: RAFUT represents a safe and effective surgical technique for intravesical ureteral tapering during pediatric robotic-assisted ureteric reimplantation. This innovative approach addresses the challenges posed by intravesical surgery for dilated ureters, maintains anatomical orientation, and offers precise excision and suturing capabilities.

Keywords: Foley tie; intravesical ureteric reimplantation; robotic surgery; ureteric tapering.

Figure 1

Bladder marking and port planning. (a) Bladder outline is marked during cystoscopy. (b) Adequate (minimum 6 mm) space is ensured between the camera port and the working ports. (c) Port planning for a typical patient (inset: actual image after port insertion). ASIS: Anterior superior iliac spine

Figure 2

1-0 Polypropylene Loop passed through an 18-G cannula to retrieve the hitch stitch

Figure 3

Final appearance after port placement: (a) Camera port in the center and working ports on the sides, (b) suprapubic assistant port opposite to the camera port

Figure 4

Foley tie to the ureter followed by ureteric alignment and stabilization with Foley tie (inset)

Figure 5

Ureteric tapering: (a) anterior wall, (b) posterior wall

Figure 6

(a) Appearance after reconstruction of the ureter. (b) Final appearance after ureteric reimplantation