Single-port Robot-assisted Ureteral Reimplantation via Low Anterior Access: Step-by-step Procedure and Preliminary Comparative Results

Background and objective: Multiport robotic management of distal ureteral strictures is still burdened by the mandatory transperitoneal approach and the steep Trendelenburg patient position. Our aim was to describe the largest series of patients treated with single-port robot-assisted ureteral reimplantation (SP-RAUR) via a supine extraperitoneal approach, with a focus on the surgical technique, perioperative surgical outcomes, and functional results. Methods and surgical procedure: Clinical and surgical data for all consecutive adult patients treated with SP-RAUR between January 2021 and September 2023 were prospectively collected. Patients were stratified by surgical approach into low anterior access (LAA) and transperitoneal (TP) groups. Ureteral reimplantation was performed extraperitoneally with patients in a supine position. Key findings and limitations: Overall, 20 patients who underwent SP-RAUR and had minimum follow-up of 1 yr were included in the analysis, of whom 50% were treated via an LAA approach. There were no significant differences in baseline characteristics between the groups. No open conversions or intraoperative complications occurred. The operative time was shorter in the LAA group than in the TP group (165 vs 191 min; p = 0.01). In terms of perioperative features, the LAA approach was associated with lower postoperative pain and opioid use and shorter length of stay (8 vs 26.5 h; p = 0.016). No major postoperative complications or recurrent urinary obstruction were observed after median follow-up of 14.5 mo. Conclusions and clinical implications: SP-RAUR via LAA represents a feasible and safe procedure with potential to improve perioperative recovery for patients with a distal ureter stricture. Patient summary: We assessed a new robot-assisted surgery technique to treat narrowing of the tube that drains urine from the kidney into the bladder. This technique uses just a single small incision. Our results show that the procedure is safe and that patients have a quick recovery and a fast return to everyday activities. Larger studies with more patients are needed to confirm these results.