Tubo-ovarian deflection facilitates access to the ureterovesical junction in robotic ureteral reimplantation for vesicoureteral reflux in children: A novel surgical modification.

INTRODUCTION

Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a well-established surgical approach in girls with high-grade vesicoureteral reflux (VUR). Adequate exposure of the distal ureter and ureterovesical junction is crucial to achieve good outcomes.

METHODS

We present a novel modification, the medial tubo-ovarian deflection (MTOD), which improves exposure of the distal ureter by dissecting the round ligament and separating the proximal peritoneum along the white line, close to the bladder.

RESULTS

Nine girls (median age 25 months) underwent MTOD during RALUR-EV. Median console time was 105 min, and no intraoperative complications were reported. All patients were discharged the day after surgery. The short-term complications included two postoperative febrile UTIs, none of them had reflux on VCUG and one case of transient urinary retention. No ovary-related complications were reported. Median follow-up was 20 months.

CONCLUSION

Performing MTOD during RALUR-EV is safe and reproducible, with good outcomes in short-term follow-ups.