Robot-assisted Ureteroplasty With Buccal Mucosal Graft - Illustration of Technique and our Initial Experience

Abstract

Objective: Management of ureteric stricture can be challenging, especially for strictures involving a long segment in the proximal to mid ureter. We aimed to demonstrate our initial experience and technique of robot-assisted ureteroplasty with buccal mucosal graft. Patients & methods: All patients were symptomatic with diagnosis confirmed on CT urogram and retrograde ureteropyelogram. MAG-3 diuresis renogram confirmed obstruction, with a differential renal function of over 20%. A step-by-step description of our technique is demonstrated. Results: Patients underwent cystoscopy and insertion of a ureteric access sheath to enable intra-operative access into the ureter endoscopically during the procedure. Ureteric stricture sites were precisely identified using both indocyanine green and real-time retrograde flexible ureteroscopy. Non-transecting dorsal incision of the ureter was made at the level of strictures in this series. Onlay buccal mucosal grafts were used to cover the defect together with an omental wrap. Patients had an uneventful recovery and were discharged on post・operative day 1 or 2. Ureteric stent was removed 6 weeks post-operatively, and MAG-3 diuresis renogram at 3 months showed no evidence of obstruction. All patients remained symptom free at 1 year post-operatively. Conclusion: Buccal mucosal graft ureteroplasty appears to be a safe and feasible minimally invasive surgical treatment option for patients with ureteric stricture.