Robot-assisted ureteral reconstruction for the management of kidney transplant patients with ureteric complications

Abstract

Background: To evaluate the feasibility of robotic assisted ureteral reconstruction for managing ureteric complications in transplanted kidney as the minimally invasive alternative to open surgery. Methods: From January 2020 to November 2021, robot-assisted ureteral reconstruction was performed for a total of nine patients with transplanted kidney who had vesico-ureteral reflux (VUR) or ureteral stricture and had failed to treat with previous endoscopic treatments. Results: Patients were eight females and one male, mean age was 53.7±6.6. Five (55.6%) Patients underwent surgery due to VUR (grade III) on transplanted kidney while four (44.4%) patients had transplanted ureteral stricture. Seven (77.8%) received kidney transplants from living donors while two (22.2%) received from deceased donors. For VUR patients, average number of endoscopic injections were 2.2±0.8. Four transplanted ureteral stricture patients had a balloon dilatation with keeping ureteral catheter. Preoperative creatinine level was 1.1±0.2. Post-op voiding-cystourethrography (VCUG) was performed on 3.8±1.6 months. Four (80%) patients had no VUR and one (20%) had VUR regression from grade III to I. Four patients who underwent reconstruction due to anastomosis site stricture, became stenosis free without indwelling ureteral catheter. For one male patient with a long stenosis length of 5 cm, a boari flap was performed during reimplantation. In total, mean operators console time was 138.1±32.6 minutes and patients stayed in hospital for average 6.7±4.2 days. Urethral catheter was removed on 17.5±5.3 days and the ureteral catheter was removed after 4.9±1.5 weeks. The mean serum creatinine level was 1.2±0.1 mg/dL on 1 month after the surgery. The mean followed up period was 13.7±6.1 without having additional intervention after robot ureteral reconstruction. There were no recorded complications above Clavien-Dindo grade II. Conclusions: Robot ureteral reconstruction is a technically feasible and may provide effective treatment for ureteric complications in transplanted kidney as minimally invasive alternative to open surgery.