Robotic reconstruction in genitourinary tuberculosis: Surmounting technical challenges

Abstract Introduction: Genitourinary tuberculosis (GUTB) causes long ureteric strictures, bladder contracture and renal function impairment. While open reconstruction has been traditional, it entails considerable morbidity. Robotic-assisted reconstructive surgery provides three-dimensional visualisation, greater precision and expedited recovery. This study evaluates the complexities of reconstructive robotic surgery and explores strategies to mitigate them, aiming for optimal outcomes. The primary objective was to discern the surgical and technical challenges, intraoperative difficulties and perioperative complications associated with robotic intracorporeal reconstructive surgeries for GUTB. Patients and Methods: This retrospective study was conducted at a single tertiary centre. Thirteen patients were diagnosed with GUTB who underwent robotic urological procedures from January 2018 to May 2025. All patients received antitubercular treatment. Results: Thirteen patients (11 males and 2 females) with GUTB underwent robotic surgery during the study period. The mean age of the study population was 42.3 ± 13.2 years. The mean robotic console time was 236.5 ± 40.07 min, and the intra-operative mean blood loss was 122.3 ± 14.23 ml. The average follow-up period was 13.3 ± 10.01 months. This study encompassed robotic procedures, such as ileal ureter substitution, augmentation cystoplasty, Boari flap reconstruction, combined ileal ureter and augmentation cystoplasty and Studer neobladder reconstruction. Conclusions: Robotic reconstruction in GUTB is a feasible and safe procedure, even in the presence of anatomical distortion and fibrosis. Robotic platforms facilitate meticulous dissection and boost anastomosis accuracy, resulting in better outcomes and decreased morbidity.