The role of robot assisted laparoscopic surgery is rapidly expanding, particularly within the field of pediatric urology. Various techniques have been shown to be feasible and as equipment and techniques improve, more complex reconstructive procedures may be attempted. Currently, after the laparoscopic or open removal of a refluxing dysplastic renal moiety, contralateral antireflux surgery is typically performed through a separate open incision. We report a single robot assisted procedure which includes both nephroureterectomy and contralateral extravesical ureteral reimplantation.

The patient is a 13 year old female with persistent bilateral vesicoureteral reflux and right reflux nephropathy which resulted in an atrophic kidney. The nephroureterectomy was performed first followed by undocking and repositioning of the robot for the remainder of the procedure which included the contralateral extravesical ureteral reimplantation.

The patient tolerated the procedure well. There were no complications. The patient was discharged on postoperative day 2 after adequate pain control without intravenous pain medication, return of bowel function, and complete bladder emptying. Follow-up ultrasound and radionuclide cystogram were normal.

Simultaneous robot assisted laparoscopic nephroureterectomy with contralateral ureteral reimplant is a safe and viable option for patients with a dysplastic renal moiety and contralateral VUR. The key benefits is avoidance of a clinic dilemma by combining the two operations into one. The procedure also offers benefits associated with minimally invasive surgery: less pain, morbidity with a potentially rapid recovery.