Ureteral reimplantation is commonly indicated for patients with trauma or oncologic conditions affecting the distal ureter, typically necessitating the removal and reconstruction of the affected segment. The psoas hitch and Boari bladder flap repair (BFR) are the most commonly used techniques for ureteral reimplantation. These techniques facilitate the treatment of proximal ureteral lesions through reimplantation. The psoas hitch procedure involves mobilizing the contralateral bladder and attaching the bladder dome to the psoas tendon on the affected side. In contrast, the Boari bladder flap repair entails creating a bladder flap, rotating it toward the ureter, and tubularizing it to form an anastomosis with the remaining healthy ureter. Minimally invasive ureteral reimplantation has gained increasing attention in recent years. Here, we present a successful case of reconstructing a left middle-third ureteral stricture using robotic left ureteral reimplantation with a Boari flap.

We present a case utilizing the Da Vinci Xi robotic system to perform a robotic-assisted Boari flap repair.

The patient is a 73-year-old female with a history of left middle-third ureteral stricture and hydronephrosis, requiring regular double J stenting. A retrograde pyelogram revealed a long stricture extending 10 cm from the left ureteral orifice. The patient opted for robotic-assisted left ureteral reimplantation with a Boari flap to resolve the double J stenting requirement. The surgery was performed without complications, with an estimated blood loss of 30 mL. During a follow-up visit one week postoperatively, the patient was recovering well. Cystography showed no contrast medium leakage at the anastomosis site, and the Foley catheter was removed. The ureteral stent was subsequently removed four weeks postoperatively.

Robotic-assisted Boari bladder flap repair is a safe and effective option for carefully selected patients. Our case demonstrates a successful functional outcome, emphasizing the valuable role of robotic technology in ureteral reconstruction. Additionally, the continued advancement of robotic-assisted techniques may further enhance surgical precision and patient recovery in complex ureteral repairs.