The robot-assisted ureteral reconstruction in adult: A narrative review on the surgical techniques and contemporary outcomes

Abstract

Despite the rapid increase in the use of robotic surgery in urology, the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches. This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones, and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems. However, with the potential benefits of minimal invasiveness, several pioneering reports have been published on robotic surgery in urology. By reviewing the literature on this topic, we aimed to summarize the techniques, considerations, and consistent findings regarding robotic ureteral reconstruction in adults. Robotic applications for ureteral surgery have been primarily reported for pediatric urology, especially in the context of relieving a congenital obstruction in the ureteral pelvic junction. However, contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant, iatrogenic, and traumatic conditions, which generally occur in adult patients. Nevertheless, the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population; thus, qualified prospective trials are needed for wider acceptance. However, contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction, even in the absence of haptic feedback, which can be compensated by various surgical techniques and enhanced three-dimensional visualization.

Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral stricture

“…Most of the current studies on minimally invasive ureteroplasty in BMG have focused on the robot-assisted procedure ( 6 , 7 , 18 , 19 ). Arora et al reported no data for recurrence during the 6-month follow-up period ( 20 ).…”

“…The first BMG ureteroplasty in humans was described in 1999 (4). However, interest in this technique has renewed over the past decade, and the technique is now reported in numerous articles regarding its utility in open and robotic approaches (5)(6)(7). Unfortunately, there is a lack of papers dedicated to the laparoscopic BMG ureteroplasty of the complex upper ureteral stricture, being necessary to build a confident opinion on the pros and cons of different approaches (8,9).…”

Double-J Stent Misplacement in the Inferior Vena Cava and Right Atrium: A Urovascular Nightmare

“…Robot-assisted ureteral reimplantation has comparable outcomes to those with open and laporoscopic approaches in the hands of experienced robotic surgeons [1] , [2] . Ureteral reimplantation is commonly performed in the management of ureteral strictures and after ureteral injuries.…”