Robot‐Assisted Ileal Ureter Replacement: Comparisons Between Totally Intracorporeal and Extracorporeal Ileal Segment Preparation

BACKGROUND: The comparative perioperative outcomes of totally intracorporeal robot-assisted ileal ureteral replacement (TI-RAIUR) versus that of RAIUR with extracorporeal ileal segment preparation (RAIUR-EI) remain undefined. This study pioneers a comparative analysis between these approaches to guide clinical individualised therapy. METHODS: Thirty-four patients who underwent RAIUR (22 via RAIUR-EI and 12 via TI-RAIUR) were included. Baseline characteristics, perioperative outcomes, and follow-up data were systematically compared. RESULTS: There were no between-group differences in baseline characteristics. The RAIUR-EI approach significantly reduced the reoperation time for initial failed procedures. Both groups achieved 100% 1-year subjective success and stable long-term renal function. The complication rates were statistically similar, although one Clavien-Dindo III incisional hernia occurred in the RAIUR-EI group. In addition, the TI-RAIUR approach demonstrated better aesthetic outcomes. CONCLUSIONS: Both techniques achieve reliable outcomes for long-segment ureteral reconstruction. The RAIUR-EI approach may optimise efficiency in more complex cases, whereas the TI-RAIUR technique results in better aesthetic outcomes.