Ileal ureter substitution is usually considered the last resort for the reconstruction of long-segment ureteral defects, and completely intracorporeal surgery is a challenging task. In this video, we present our experience and technique of modified bladder-first approach for robot-assisted completely intracorporeal ileal neoureter, emphasizing its notable advantages.
Four patients underwent robot-assisted ileal ureter replacement at our institute. Complete assessment of stricture location and length was performed prior to definitive repair. Demographic, peri-operative, and follow-up data were recorded. Video-based illustration highlights the modified surgical technique, technical nuances, and challenges encountered.
Among the 4 patients, 2 were males, and 2 were females, with a mean age of 28 years. The surgical indications included benign ureteral stricture following lithotripsy or sequelae of genitourinary tuberculosis. Two patients underwent conventional ileal ureter, and 2 underwent bladder-first approach. The mean operating time was 370 +/-10 minutes and 287.5 +/-2.5 minutes, respectively, for conventional and bladder-first approaches. Clavien-Dindo grade 2 and grade 3a complications were found in one patient each. At a median follow-up of 18.3 months, all the patients experienced symptomatic and radiologic relief, with preserved renal function.
Our video of the bladder-first approach for ileal ureter replacement highlights its safety and feasibility. By minimizing intraoperative time and reducing the patient position change, and undocking to a single occurrence, this modified technique shows promising potential. This signifies a paradigm shift in the management of long-segment ureteral defects, setting the stage for improved outcomes.


Declaration
Ethical approval and consent to participate: Ethical approval was obtained from the Institutional Ethics Committee, and written informed consent to participate was obtained from the patient. Patient consent statement for publication: The authors have received and archived patient consent for video recording/publication in advance of the video recording of the procedure. Written informed consent for the publication of details, images, and videos was obtained from the patient.