Robot-assisted laparoscopic megaureter tapering with ureteral reimplantation: Tips and tricks

Objective The aim was to demonstrate surgical techniques used in pediatric robot-assisted laparoscopic megaureter tapering (RALMT) with ureteral reimplantation. We report on our preliminary experience. Methods We reviewed video of patients who underwent RALMT with ureteral reimplantation between August 2012 and November 2015. MT was performed extravesically and ureteral reimplantation was performed by extravesical detrusorrhaphy with ureteral anchoring. All patients had an intraoperatively placed ureteral stent. Results Between August 2012 and November 2015, 14 patients underwent RALMT with ureteral reimplantation. Highlighted techniques include variations in ureteral stent insertion, method of excisional tapering, and approach to reimplantation. All (10/10) patients with postoperative ultrasounds following ureteral stent removal demonstrated radiographic improvement at a mean follow-up of 9 months. No patients had postoperative febrile urinary tract infections. The only complication was one patient with postoperative ileus. Conclusions We demonstrate variations in surgical techniques which may facilitate the surgical steps of RALMT with ureteral reimplantation. Our preliminary experience suggests the procedure is safe and feasible for pediatric patients with symptomatic megaureter.