Robot-assisted laparoscopic ureteral reimplantation with excisional tailoring for refluxing megaureter

ObjectiveTo demonstrate a novel technique for robot-assisted laparoscopic excisional tailoring and reimplantation of a refluxing megaureter.MethodsA 9-year-old boy with dysfunctional elimination was found to have a refluxing megaureter and diminished ipsilateral renal function. Robotic ureteral reimplantation with excisional tailoring was performed using a three-port approach. Stay sutures were placed in the anterior aspect of the distal ureter and sequentially lifted to allow freehand excision of redundant ureter. The ureterovesical junction was left intact, and the ureter was repaired over a 6 Fr double-J stent. Detrusorotomy to create flaps for ureteral tunneling was performed with a carbon dioxide (CO₂) laser.ResultsThe patient's vesicoureteral reflux was successfully corrected, and he is now asymptomatic.ConclusionSpecific technical modifications can facilitate robotic megaureter repair with intracorporeal excisional tailoring. The CO₂ laser is advantageous for detrusorotomy.