Outcomes of Robot-Assisted Ureterocalicostomy in Secondary Ureteropelvic Junction in Adults: Initial Experience Using Da Vinci Xi System with Near-Infrared Fluorescence Imaging

Aim: To report the surgical technique and early outcomes of robot-assisted ureterocalicostomy (RAUC) with near-infrared fluorescence (NIRF) in the management of secondary pelvi-ureteric junction obstruction (PUJO) in adults. Materials and Methods: The data of 6 patients who underwent RAUC using Da Vinci Xi system with NIRF technology between November 2017 and April 2019 were retrospectively reviewed. Indication was secondary PUJO due to previous failed pyeloplasty. The outcome variables evaluated include operative time (total and console), length of hospital stay, blood loss, and complications. Success was defined as the absence of pain and radionuclide scan demonstrating nonobstructive drainage and improvement/stabilization of split function of the renal moiety. Results: The mean (range) patient age was 33.7 (18-41) years. Total mean (range) operating time was 178 (140-240) minutes and mean console time was 135 minutes. Estimated mean blood loss was 115 (50-200) mL and average hospital stay was 6.1 (5-8) days. There were no conversions to open or laparoscopic surgery. Clavien-Dindo complications occurred in 2 patients. (Grade I-1 and Grade II-1). After a median (range) follow-up of 15 (6-22) months, all 6 patients had successful clinical and radiological outcomes. Conclusion: RAUC is a safe and feasible technique with acceptable outcomes in the setting of secondary PUJO. The utility of NIRF in determining vascularity of the ureter seems to be promising in this setting. Multi-institutional prospective studies with large patient cohort are necessary to validate the role of robotic platform in ureterocalicostomy in the reoperative settings.