Robotic-Assisted Laparoscopic Repair of Kidney Transplant Ureteral Strictures

Background and Objective To evaluate outcomes of robotic assisted transplant ureteral repair (RATUR) for the management of kidney transplant ureteral strictures (TUS). Methods We retrospectively analyzed 41 consecutive patients who underwent RATUR for TUS at multiple tertiary referral centers between January 2016 and December 2022. RATUR was performed utilizing a robotic assisted transperitoneal approach. The primary outcome was stricture recurrence rate and secondary outcomes included postoperative complicate rate, determining factors impacting with allograft functional recovery, and rate of conversion to open surgery. Categorical and continuous variables are displayed as total number (Percentage) or median [Interquartile Range] respectively. Pearson correlation coefficient was utilized to assess categorical variable correlation with creatinine. Results The median age was 56 years [44, 66]. The female to male ratio was 1.1:1. Approximately 66% of patients were dialysis dependent prior to kidney transplantation. TUS was identified at a median time of 4 months [2, 15.5] following kidney transplant. Median stricture length was 2 cm [1.22, 2.9cm]. There were no TUS recurrences with a median follow-up of 36 months [24, 48]. There were 3 Clavien Grade 2 and 1 Clavien grade 3 complications (9.5%). No baseline characteristics or preoperative diagnostics were correlated with a long-term decline in renal allograft function. Conclusion RATUR has excellent and durable outcomes with low complication rates. These findings encourage the use of a minimally invasive definitive repair as a first line treatment option for the management of TUS.