First Russian experience with robot-assisted laparoscopic extravesical transverse ureteral reimplantation for ureterovesical junction anomalies in children using the da Vinci Xi robotic system

Introduction. Robot-assisted extravesical ureteral reimplantation (RAEUR) is one of the most performed procedures on the da Vinci Xi robotic platform in children with ureterovesical junction pathology. Robot-assisted extravesical transverse ureteral reimplantation represents the most frequently performed intervention using the da Vinci system in this patient population. We report our initial experience with RAEUR using the da Vinci Xi system, which forms the basis of this communication.

Objective. To analyse our experience with robot-assisted extravesical ureteral reimplantation in children using the da Vinci Xi robotic platform.

Materials & methods. The study included 12 patients with a mean age of 3.9 ± 2.9 years (minimum age 7 months). Mean anthropometric parameters were: height 101.4 ± 20.4 cm, body weight 17.4 ± 7.7 kg. Gender distribution: 8 boys (66.7%) and 4 girls (33.3%). Mean anteroposterior renal pelvic diameter was 21.7 ± 7.1 mm. Ureterovesical junction pathology was detected antenatally in 5 patients (41.7%) and postnatally in 7 (58.3%). Urinary tract infection was noted in 4 (33.3%) patients. The nosological spectrum included ureterovesical junction obstruction (UVJO) in 11 (91.7%) patients and vesicoureteral reflux (VUR) in 1 (8.3%) patient. The procedure was performed with the patient in the supine position, using three 8-mm trocars for the optics and robotic instruments and one 5-mm trocar for assistant instruments.

Results. No conversions occurred. Operative time for the initial cases was 175 minutes. In the most recent cases in the series, operative time remained approximately the same, with a mean duration of 170.4 ± 31.5 minutes. Mean docking time was 22.5 ± 2.4 minutes, and mean console time was 99.2 ± 28.6 minutes. Mean anteroposterior pelvic diameter decreased from 21.8 ± 7.1 mm preoperatively to 11.1 ± 4.3 mm postoperatively after cessation of drainage.

Conclusion. Analysis of our initial experience with RAEUR demonstrates its advantages over other ureteral reimplantation techniques, particularly the preservation of the surgeon's physical condition throughout the procedure, enabling precise intracorporeal ureteral tapering and anastomosis formation while avoiding the ergonomic challenges and operator fatigue associated with laparoscopic extravesical reimplantation. Our findings confirm the safety and efficacy of RAEUR in children and support its broader adoption into routine clinical practice.

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