Robotic Appendiceal Ureteroplasty for Complex Right-sided Ureteral Strictures: Technical Approaches and Midterm Outcomes

Background: Reconstruction of complex ureteral strictures remains challenging. The appendix provides an autologous alternative for ureteral reconstruction, distinguished from oral mucosal grafts by its intrinsic vascularity. Objective: To describe robotic appendiceal ureteroplasty (RAU) techniques and evaluate their midterm outcomes. Design setting and participants: From May 2019 to September 2024, 31 patients with right-sided complex ureteral strictures underwent RAU at a single institution. All procedures were performed using a robotic single-docking approach. Perioperative and follow-up data were prospectively collected. Intervention: Robotic appendiceal ureteroplasty (RAU) using four different surgical techniques (single-docking approach), depending on stricture location and length. Outcome measurements and statistical analysis: Outcomes included operative time, estimated blood loss, length of hospital stay, perioperative complications, and overall success rate (symptom relief and radiographic patency). Descriptive statistics were used; success rate is reported with 95% confidence interval. Results and limitations: Ureteral strictures were located between the ureteropelvic junction and mid-ureter in 29 patients (93.5%). Mean (range) stricture length was 5.5 (3-25) cm. Mean operative time was 176.4 (99-265) min, estimated blood loss was 42.7 (10-200) ml, and postoperative hospitalization was 4.5 (3-12) days. No open conversions or major perioperative complications occurred. Median (range) follow-up was 28 (12-67) months. The overall success rate was 100% (30/30; 95% CI 88.4%-100%). Limitations include the single-center design, lack of a control group, and limited sample size. Conclusions: RAU is a safe and effective approach for managing complex right-sided ureteral strictures; however, careful patient selection is essential, taking into account both the characteristics of the stricture and the condition of the appendix.