Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): a narrative review

Background and Objective: In the last two decades, the treatment of vesicoureteral reflux (VUR) benefits from the introduction of robot-assisted laparoscopy surgery in pediatric population. This article aims to review the advantages of robot-assisted laparoscopic extravesical ureteral reimplantation (RALUREV) in pediatric patients with VUR and provides an update on surgical outcomes. Methods: A literature search of PubMed and MEDLINE databases was conducted. All the articles, published between 2010 and 2022, describing clinical outcomes of patients with VUR after treatment with RALUR-EV, were considered to be relevant for the purpose of the study. The results were synthetized as a narrative review. Key Content and Findings: Twenty-one studies were included. Of them, 19 (90.5%) presented a retrospective design. These articles involved 1,321 children and 1,914 ureters who underwent RALUR-EV. The mean age at the procedure was 6 years, and the mean follow-up length was 20.4 months. The overall success rate of surgery was 92.2% for patients and 90.9% per ureter. The mean operational time was 175.4 minutes for unilateral reimplantation and 200.3 minutes for bilateral reimplantation. The mean length of stay was 1.9 days. Conclusions: The article discusses the adoption of RALUR-EV, its advantages, the heterogeneity of study protocols, and the evolution of surgical techniques. It also highlights the need for standardized protocols and prospective studies to further understand the advantages of RALUR-EV.