Surgeon-controlled robotic ureteral surgery.

PURPOSE OF REVIEW: Surgeon-controlled, robotic-assisted, ureteral reconstructive and ablative surgery is being performed routinely for both benign and malignant pathology at centers possessing this technology in their armamentarium. The aim of this review is to detail the options for surgeon-controlled robotic management of ureteral pathology and evaluate the developments in the last 2 years.

RECENT FINDINGS: Surgeon-controlled robotic management of ureteric pathology involving all parts of the ureter with varying cause has been reported. Proximally, ureteral strictures and symptomatic retrocaval ureters have been repaired with long-term follow-up demonstrating resolution of obstruction. Ureterolysis and other mid-ureteral pathology have been treated with durable function results. Transitional cell carcinoma of the renal pelvis or distal ureter has been extirpated with successful oncologic outcomes. Reimplantation of refluxing ureters in children has been demonstrated to provide similar results of open surgery.

SUMMARY: Surgeon-controlled, robotic-assisted ureteral surgery is well tolerated, feasible, and effective for ablative and reconstructive indications with minimal complications. Knowledge of anatomy, pathology, experience of surgical team, and appropriate preoperative patient selection augmented with proper port placement to provide excellent exposure is critical to provide optimal outcomes.