Robotic Ureteroenteric Stricture Repair: A Decade of Surgical Experience and Technique Evolution

BACKGROUND: Ureteroenteric strictures (UES) are a challenging complication after urinary diversion and may lead to infection, renal dysfunction, and the need for reintervention. Robotic repair has emerged as an effective minimally invasive option, but data remain limited, particularly in complex and heterogeneous cohorts. METHODS: We conducted a retrospective review of 40 patients who underwent robotic UES repair at a single tertiary center between July 2014 and May 2024. Seventeen patients were treated with the Xi system and 23 with the single-port (SP) platform, all by a single experienced surgeon. Patient demographics, stricture characteristics, operative details, perioperative outcomes, and follow-up data were analyzed. Surgical success was defined by symptom resolution, stent- or nephrostomy-free status, radiological patency, and stable renal function. RESULTS: A total of 40 patients representing 50 ureteral units were included. The cohort included a range of stricture characteristics and reconstructive approaches. Primary anastomosis was most commonly performed for shorter strictures, whereas flap, graft, and interposition techniques were used for longer or more complex disease. Overall, robotic repair was associated with high success rates (95%) and acceptable morbidity (12.5% major complications). Perioperative outcomes improved over time, with reductions in operative time, blood loss, and length of stay, likely reflecting increasing surgical experience and technical refinement. CONCLUSIONS: Robotic repair of UES is safe and effective across both multiport and SP platforms. This series reflects a decade of evolving technique and highlights practical refinements that facilitate reconstruction in complex postdiversion cases.