Robotic-assisted laparoscopic ureterocalicostomy: the experience of two German centers

BACKGROUND: Ureterocalicostomy can give successful and rewarding solutions to complicated urological anomalies and complications. The purpose of this study is to present our technique for robotic-assisted laparoscopic ureterocalicostomy and to report the outcomes of nine consecutive patients who underwent robotic-assisted laparoscopic ureterocalicostomy in two German Centers, from 2014 to 2024.METHODS: Data of patients who underwent robotic-assisted ureterocalicostomy, from 2014 to 2024, i5wo Centers, were retrospectively collected and analyzed. Preoperatively, a retrograde ureteropyelography was performed. A transperitoneal approach with the Hassan technique was used, followed by the introduction of four additional trocars. Then the X or the Xi Da Vinci robotic system was docked.RESULTS: In total nine patients have undergone robotic-assisted laparoscopic ureterocalicostomy in two German centers, up to now. Three patients have undergone previous failed pyeloplasty, one patient has undergone multiple previous stone surgeries, one patient has undergone previous partial nephrectomy for a benign tumor, three patients had ureteropelvic junction obstruction with intrarenal pelvis and one patient has undergone previous open kidney stone removal. The mean operative time was 184.78±53.35 minutes. Seven patients had an uneventful postoperative course. One patient had prolonged extravasation, needing a prolonged JJ stent and one patient needed placement of a nephrostomy tube, due to second degree hydronephrosis.CONCLUSIONS: Robotic-assisted ureterocalicostomy is a feasible, safe and efficient approach for patients requiring reconstruction of the upper urinary tract, in whom other, more widely performed, interventions have failed are cannot be applied. The implementation of additional studies, with larger populations and of higher-quality is of utmost importance, so as that safer conclusions can be drawn.