Robot-assisted appendiceal interposition in a child with a long ureteral stricture: A case report and literature review

Long ureteral strictures represent a significant surgical challenge, particularly when they are not amenable to endoscopic management and require reconstructive intervention. This article presents a clinical case of robot-assisted ureteral substitution using the appendix in a child with an extended ureteral stricture, along with a review of various robotic techniques for ureteral reconstruction. A 10-year-old boy with a right-sided nephrostomy catheter was admitted to the Irkutsk Regional Children’s Clinical Hospital. Imaging revealed a ureteral stricture approximately 4 cm in length, which developed following a previously unsuccessful ureterolithotomy. The procedure was performed using a robot-assisted laparoscopic approach. The appendix was mobilized and interposed into the defect resulting from excision of the fibrotic ureteral segment. The appendix was mobilized into the bed of the resected ureteral segment and positioned in an isoperistaltic orientation. The tip of the appendix was resected. Under direct vision and using an antegrade approach, a double-J stent was inserted through the appendix, with one end placed in the renal pelvis and the other in the bladder. Two anastomoses were constructed: a pyeloappendicostomy between the renal pelvis and the appendix, and an appendicoureterostomy between the appendix and the distal ureter. The total operative time was 385 minutes, including 15 minutes for robot docking and 370 minutes of console time. The procedure was performed entirely intracorporeally, without the need for redocking. No intraoperative complications occurred. The postoperative course was uneventful. The drain was removed on postoperative day 2 following a control ultrasound. The patient was discharged on postoperative day 8, and the ureteral stent was removed 4 weeks after surgery. An antegrade nephrostogram performed one month postoperatively confirmed ureteral patency up to the bladder. Robot-assisted laparoscopic appendiceal interposition for long ureteral strictures appears to be a safe and feasible surgical option.