Robotic ureteral re-implantation

The surgical robot is computer-based, simulating the surgeon's hand movements. This enables minimally invasive procedures to use the smallest possible wound. So the surgical robot offers easy access to areas that are difficult to reach and improves accuracy and control through a magnified image. This advanced technology can treat many complex conditions, including cases that require ureteral implantation.

The ureters are two tubes that carry urine from the kidneys to the bladder, each connected to one kidney and thus forming part of the urinary system. Sometimes, the position where the ureter connects to the bladder is abnormal, and surgery is required to correct it. This surgery is called ureteral re-implantation surgery.

The abnormal position of the ureters can cause a condition called vesicoureteral reflux (VUR), in which the valves where the ureters meet the bladder cannot close properly, allowing urine to back up into the ureters from the bladder, which poses a risk of recurrent urine infections and kidney damage. The seriousness of such conditions lies in the risk of the kidney losing its function over time if surgical intervention is not performed in the specified period.

Ureteral re-implantation surgery can solve the problem by changing the positions where the ureters enter the bladder so they become surrounded by the bladder muscle, which prevents urine from flowing backward.

 

The patient is subjected to general anesthesia. Then Prof. Mahmoud AbdElHakim begins to separate the ureters. Then he creates a new, better position. The ureter is then placed in its new position and sutured in place. The old hole is also closed with stitches.

This surgery generally takes 2-3 hours. The surgery was performed as traditional or laparoscopic surgery. Recently, the surgery can be done with the help of a robot with Prof. Mahmoud AbdElHakim, Professor of Urology, Cairo University. This robot offers 3D vision, precise control from the control unit, and extremely accurate angles, all of which are necessary to prevent damaging the micro vessels.

Robotic-assisted ureteral re-implantation involves very small skin incisions, while traditional open surgery involves long skin incisions. Therefore, traditional surgeries are linked to serious consequences due to common co-morbidities, including diabetes and obesity as well as risk factors like smoking and immunosuppressive medication. Furthermore, the size of the wound determines the severity and duration of the postoperative pain, as well as the painkillers administration period, the hospitalization and recovery time, and the plastic outcome. While minimally invasive robotic surgery has several significant benefits that include:

- Improving cosmetic outcomes for surgical wounds of a small size.

- Lowering the risk of surgical complications and wound infection.

- Minimal blood loss.

- Reducing hospitalization time.

- Faster return to daily life. 

- Greater precision in identifying the primary areas to be treated; this protects surrounding tissues and cells from injury or bleeding.

These goals are desirable in all ureteral re-implantation patients, particularly who have significant comorbidities. 

The robotic repair offers significant advantages for both the patient and the surgeon who has expertise in robotic surgery in the field of urology, Prof. Mahmoud AbdElHakim, Professor of Urology, Cairo University.