Robotic-assisted Uretero-ileal reimplantation in ileal conduit

• Robotic-assisted repair of Uretero-ileal Strictures is emerging as a new standard of care. • The procedure combines an elevated success rate with a favorable complication risk. • This surgery is extremely complex and should be limited to centers with a high level of experience with robotic-assisted surgery. We herein present a video of a robotic-assisted uretero-ileal reimplantation in an ileal conduit. The patient was a 74 year old male who had undergone robotic assisted radical cystectomy with intracorporeal ileal conduit in 2022. Pathology showed urothelial cell carcinoma pT2N0. In amrch 2023 the patient was admitted in our clinic with left side flank pain and sepsis. A CT scan showed severe lefthydronephrosis on a left sided uretero-ileal stricture. A nephrostomy tube was patient and, after management of sepsis, an endoscopic balloon dilatation of the stricture was performed in may 2023. Patient experienced a stricture recurrence in September 2023. We thus decided to perform robotic assisted uretero-ilal reimplantation. Patient was positions in dorsal decubitus and robotic trocarts were positioned as for radical cystectomy. Extensive adhesiolysis was performed. A stay suture was then positioned on the ileal conduit to traction it towards the abdominal wall. Dissection of the retroperitoneum was then performed medial to the ileal conduit, in order to identify the left ureter. The right ilac vessels are exposed to avois inadvertent injury. ICG is instilled via the left nephrostomy, helping the surgeon to identify the left ureter. Gven the massive fibrosis of the ureter, this structure is not mobilized and the ileal loop is brought down to the ureter. A side to side anastomosis is performed using 4/0 vycril. A 7F monoJ catheter is positioned and externalized using a foley catheter as carrier. OR time was 155 minuted and estimated blood loss 50cc. Post operative course was uneventful and patient was discharged on POD 2.