Korean J Transplant.  2022 Nov;36(Supple 1):S165. 10.4285/ATW2022.F-2887.

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

• Shin D
• Rhew Sa
• Yoon CE
• Kwon HJ
• Bang S
• Moon HW
• Cho HJ

• KMID: 2535681
• DOI: http://doi.org/10.4285/ATW2022.F-2887

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 ureter-al 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 re-construction 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.