A case series of five robot-assisted retrocaval ureter repair – multicenter experience

Background: We aimed to summarize cases of robot-assisted retrocaval ureter (RCU) repair at three high-volume medical centers. Materials and methods: We retrieved all RCU cases surgically treated between 2017 and 2026. Demographic, surgical, and postoperative data were analyzed. Results: One male and four females underwent robot-assisted RCU repair. The mean age was 23 years (range, 15.5–40). Right flank pain was the leading symptom in three patients, and two patients experienced recurrent urinary tract infections (UTIs) associated with the condition. In three patients, preoperative renal scans demonstrated delayed radiotracer excretion without complete obstruction. All patients underwent preoperative imaging that demonstrated hydronephrosis: severe in two patients, moderate in two, and mild in one. Ureteral transection was carried out at the level of the uretero-pelvic junction in two cases, and at the level of the inferior vena cava adjacent to the L3–L4 vertebrae in the remaining three. Four types of absorbable sutures were used for the anastomosis, and in four cases a running suture was used. Total and skin-to-skin operative times were 211 and 145 minutes, respectively. The mean hospital stay was 1.8 days, and the stent was removed after a mean of 41 days (range, 29–55). One patient was readmitted on postoperative day 24 due to UTI. Another patient was readmitted for pain control after stent removal. Mean follow-up was 23.4 months (median, 11; range, 8–60). Postoperative ultrasound showed hydronephrosis to a lesser extent than preoperatively. Conclusion: Given the limited information on robotic repair of RCU, important technical aspects remain unresolved. Further studies with longer follow-up periods are required to establish standardized surgical principles.