Tubo-ovarian deflection facilitates access to the ureterovesical junction in robotic ureteral reimplantation for vesicoureteral reflux in children: A novel surgical modification.

Introduction: Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a well-established surgical approach in girls with high-grade vesicoureteral reflux (VUR). Adequate exposure of the distal ureter and ureterovesical junction is crucial to achieve good outcomes.

Methods: We present a novel modification, the medial tubo-ovarian deflection (MTOD), which improves exposure of the distal ureter by dissecting the round ligament and separating the proximal peritoneum along the white line, close to the bladder.

Results: Nine girls (median age 25 months) underwent MTOD during RALUR-EV. Median console time was 105 min, and no intraoperative complications were reported. All patients were discharged the day after surgery. The short-term complications included two postoperative febrile UTIs, none of them had reflux on VCUG and one case of transient urinary retention. No ovary-related complications were reported. Median follow-up was 20 months.

Conclusion: Performing MTOD during RALUR-EV is safe and reproducible, with good outcomes in short-term follow-ups.