Robotic Augmented Anastomotic Appendiceal Onlay for Ureteral Stricture

Introduction and Objective: The management of ureteral strictures is challenging for urologists depending on the length and location of the stricture. Primary ureteroureterostomy is a potential surgical option for ureteral strictures, but can be challenging in strictures >2 cm in length. Onlay grafts, such as appendiceal onlay, have been described as safe and viable options for management of ureteral strictures. In this study, we present a case where a right proximal ureteral stricture is treated with a robotic augmented anastomotic appendiceal onlay for ureteral reconstruction. Methods: This procedure was performed using the da Vinci Xi® robotic system. Intraoperative ureteroscopy identified an 8 cm ureteral defect with an ~1 cm obliterated ureteral segment. An augmented anastomotic appendiceal onlay was performed because of the length and location of the ureteral stricture. Results: Estimated blood loss was 50 mL. There were no intraoperative or postoperative complications. As a part of the patient's follow-up care, a renal-bladder ultrasonography 8 weeks after the procedure demonstrated resolution of right hydronephrosis and no obstruction was noted on mercaptuacetyltriglycine renal scan with Lasix. Conclusions: In summary, robotic ureteral reconstruction with augmented anastomotic appendiceal onlay is a unique and innovative strategy for ureteral reconstruction. No competing financial interests exist. The authors whose names are listed certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this article. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4:58