Robot-assisted Laparoscopic Bilateral Ileal Ureter in Duplex Ureter With Strictures After Treatment Failure of Allium Stents

Ureteral injury and vaginal fistula are common complications after surgical treatment and radiotherapy of gynecological tumor.1,2 Ureteral injury in duplex system is more challenging and rarely reported.3 OBJECTIVE: We report our surgical techniques of totally intracorporeal robot-assisted bilateral ileal ureter in a patient who had a bilateral ureteral injury with duplex ureter.We present a case of a 61-year-old female who suffered from flank pain and vaginal fistula due to ureteral injury after a radical hysterectomy and radiotherapy for cervical cancer. After repeated ureteral stenting and failure of Allium stent, we performed a bilateral ileal ureter in "7" configuration using robotic assisted laparoscopy. Surgical technique is detailed in the video.Total operative time was 252 minutes with 100 mL estimated blood loss. The length of ileal segment was 25 cm. There was no conversion to laparoscopic or open surgery. No blood transfusion was required. Left and right abdominal drains were removed on seventh and 11th day after the surgery, respectively. The double "J" tubes were removed 2 months later. After 6 months of follow-up, the patient's symptoms were relieved, and the serum creatinine and eGFR were 101.50 μmol/L and 50.418 mL/min·1.73 m2, respectively. Ultrasound revealed improved mild hydronephrosis. No complications occurred.We successfully performed a totally intracorporeal robotic ileal ureter in "7" configuration. Previous surgical history, radiotherapy, and duplex ureter have increased the difficulty in the reconstruction of ureteral injury. It is necessary to adjust the reconstruction strategy according to the intra-operative findings.