Videosurgery
Robotic retrocaval ureter repair
Maxwell Sandberg1, Randall Bissette2, Ashok Hemal1
1Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina,, United States
2Virginia Tech Carilon School of Medicine,Roanoake, Virginia, United States
Citation: Sandberg M, Bissette R, Hemal A Robotic retrocaval ureter repair. www.ceju.online/journal/2025/retrocaval-ureter-2398.php
Key Words: retrocaval ureter

Patients with a retrocaval ureter (RU) have their ureter mispositioned posterior to the inferior vena cava (IVC). RU tends to present in the third to fourth decade of life. Patients are often symptomatic, with flank pain, abdominal pain, and recurrent urinary tract infections with imaging showing associated right-sided hydroureteronephrosis. Surgical repair is indicated for those with symptoms or worsening renal function, with various options including pyelopyelostomy and ureteroureterostomy (UU). Herein, we present robotic RU repair (RRUR) of an80-year-old male patient with right-sided RU via UU without the need for spatulation of the ureter. Preoperatively, the patient was worked up for benign prostatic hyperplasia with lower urinary tract symptoms and flank pain. A urinalysis revealed bacteriuria so a renogram was obtained, which revealed normal kidney function and partial obstruction of the right kidney. The patient elected to undergo RRUR with the da Vinci Xi robot. He was placed in left lateral decubitus (right side up) and a foley catheter was inserted. There were 4–8mm robotic ports and 1–5mm air seal used. The robotic ports were placed in a row 5 cm apart from one another, with the middle port centered above the umbilicus, and the air seal port 5 cm inferior to the robotic ports. The robot was docked, and the colon was Kocherized. The dissection was carried down to the right renal pelvis to identify the ureter. Next, the inferior vena cava (IVC) was exposed, and the ureter was seen passing posterior to it. Cautery was used to mark the ureter at the point of maximal hydroureter, and it was transected. The inferior portion of the ureter was then pulled anteromedial to the IVC. The diseased ureter was trimmed proximally, and the anastomosis proceeded via UU to reattach the ureter. This was done with 5-0 running vicryl suture, without the need for spatulation. A 6 × 30 JJ stent was placed into the ureter prior to completion of the anastomosis. The anastomosis was completed with additional reinforcing 5-0 vicryl, and the case was then completed. The robot was undocked. All port sites were closed with 4-0 monocryl suture.The patient was discharged on postoperative day 1 without complication, and their catheter was removed at this time. RRUR provided excellent visualization and ease of identification of the ureter.

Article history
Submitted: 10 December, 2024
Accepted: 12 February, 2024
Published online: 28 January, 2025
doi: 10.5173/ceju.2024.0251
Corresponding author
Maxwell Sandberg
email: maxwellsandberg@msn.com
Conflicts of interest:  The authors declare no conflicts of interest.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/).
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