title: Robot-Assisted Ureteral Reconstruction Using Buccal Mucosa.
abstract: OBJECTIVE
  To describe the technique of robotic buccal mucosa graft ureteroplasty as a minimally invasive alternative method of ureteral reconstruction for proximal or multifocal ureteral strictures not amenable to primary anastomosis.
  
  
  METHODS
  Between October 2013 and May 2014, we performed robotic-assisted ureteral reconstruction using buccal mucosa grafts in four patients (mean age 41.5, range 23-67). The indication for surgery was a proximal or multifocal stricture not amenable to ureteroureterostomy or ureteropyelostomy. Buccal mucosa grafts were harvested to be the length of the strictured segment and 1 cm in width and placed in the ureter as an anterior or posterior onlay. Follow up was performed with diuretic renogram at least 3 months postoperatively and renal ultrasound as well as clinical assessment of symptoms.
  
  
  RESULTS
  All 4 patients underwent successful robotic-assisted reconstruction of the ureter using buccal mucosa graft. There were no intraoperative complications. At a median follow up of 15.5 months (range 10.7-18.6), there has been 100% success.
  
  
  CONCLUSIONS
  Robotic buccal mucosa graft ureteroplasty is a feasible option for reconstruction of proximal or multifocal ureteral strictures that are not amenable to primary anastomosis and it avoids the morbidity of alternative procedures.
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY. Electronic address: Lee.Zhao@nyumc.org.
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY.
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Bryk
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Adelstein
authors.affiliation: Department of Urology, New York University, Langone Medical Center, New York, NY.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D013536:Suture Techniques; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult