Repairing strictures in the mid and proximal ureter can be challenging, typically requiring ureter replacement with a segment of ileum or kidney auto-transplantation. To minimize the complications associated with bowel substitution, vascular anastomosis, and open surgical procedures, robotic buccal graft ureteroplasty presents a novel alternative for upper ureteral reconstruction.

This retrospective study include between August 2022 to February 2025, we performed robotic buccal ureteroplasty on eight patients at two institutions in Hong Kong. The selection criterion for the procedure was a benign proximal or mid ureteral stricture not amenable to primary anastomosis because of stricture length or extensive fibrosis, distal ureteral strictures were excluded. Surgical Procedure Our ureteroplasty procedure incorporates the use of a buccal mucosa graft applied onlay after resecting the stricture, or it can involve an augmented anastomotic repair for obliterative strictures. In this approach, the ureter is transected and primarily re-anastomosed on one side, while a graft is placed on the opposite side. During the operation, flexible ureteroscopy is employed to pinpoint the location of the stricture, facilitating simultaneous retrograde intra-renal surgery for any urolithiasis present. Additionally, intravascular indocyanine green is utilized to assess the vascularity of the surrounding tissue. Outcome measurements and statistical analysis Preoperative, intraoperative, and post-operative variables and outcomes were assessed. A descriptive statistical analysis was performed.

Majority (88%) of patients were urolithiasis related stricture. The onlay technique was used for 88%, while repair was carried out using the augmented anastomotic technique for the remaining case. The reconstruction was reinforced with omentum or mesenteric fat in 100% of cases. Same session retrograde intra-renal surgery was performed in 50% of cases. The ureteral stricture location was proximal in 75% and mid in 25% of cases. The median stricture length was 3.5 cm (range 2.0–6.0), operative time was 220 min (range 185–310), and length of stay was 3.5 days (range 3–9). There were no intraoperative complications. At median follow-up of 9 month, the overall success rate was 100%.

Robotic buccal graft ureteroplasty is a practical and efficient method for addressing complicated strictures in the proximal and mid ureter.