Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5802
Peer-review started: August 22, 2020
First decision: September 24, 2020
Revised: September 26, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 26, 2020
Ureteral reconstruction is a highly technical type of laparoscopic or open surgery. The incidence of ureteral injury is low; however, ureteral injuries tend to be overtreated. Robotic surgery for urinary reconstructive surgery is growing in popularity, which has made procedures such as pyeloplasty, ureteroureterostomy, and ureteroneocystostomy possible, with minimal damage to the patient. To the best of our knowledge, this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea, in a 17-year-old female patient with a ureteral injury.
The patient, a 17-year-old girl without previous medical history, was presented at the emergency room and complained of abdominal and back pain. Tenderness in the right upper quadrant was observed on physical examination. Hemorrhage in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography (CT) scan. Ureteral injury was not suspected at this time. The patient was stabilized via conservative treatment, but complained of right flank pain 3 wk later and revisited the emergency room. An enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right kidney. Retrograde and antegrade pyelography were performed. Extravasation and discontinuity of the ureter were found. A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was performed. After 3 mo, the patient did not complain of any symptoms without any abnormal radiologic findings.
This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.
Core Tip: The incidence of ureteral injuries is lower than other urinary tract injuries due to their anatomical features, located deep and surrounded by muscles or other organs. However, the small size, mobility, and location of the ureter made the operation difficult, and laparoscopic surgery was difficult to overcome the learning curve. Robotic surgery is a tool that can compensate for these shortcomings and treat patients less-invasively. This report might introduce the surgical methods and benefits of robot-assisted laparoscopic pyeloureterostomy, the first reported in Korea, and suggest that these methods can be used more widely.