Laparoscopic and robotic-assisted repair of retrocaval ureter in children: a multi-institutional comparative study with open repair

  • Maria Escolino
  • Lorenzo Masieri
  • Jean-Stephane Valla
  • Pedro Josè Lopez
  • Baran Tokar
  • Imran Mushtaq
  • Ciro EspositoEmail author
Original Article



This retrospective study aimed to report a multi-institutional experience with laparoscopic and robotic-assisted repair of retrocaval ureter in children and to compare outcome of minimally invasive surgery (MIS) with open repair.


The records of all children, who underwent MIS and open repair of retrocaval ureters in six international pediatric urology units over a 5-year period, were retrospectively collected. Data were grouped according to the operative approach: a laparoscopic group (G1) included five patients, a robotic-assisted group (G2) included four patients, and an open group (G3) included three patients. The groups were compared in regard to operative and postoperative outcomes.


At follow-up, all patients (one G1 patient after redo-surgery) reported complete resolution of symptoms and radiologic improvement of hydronephrosis and obstruction. In regard to postoperative complications, one G1 patient developed stenosis of anastomosis and needed re-operation with no further recurrence (IIIb Clavien). G2 reported the lowest average operative time (135 min) compared to G1 (178.3 min) and G3 (210 min). MIS (G1–G2) reported a significantly better postoperative outcome compared to open repair (G3) in terms of analgesic requirements, hospitalization, and cosmetic results.


The study outcomes suggest that MIS should be the first choice for retrocaval ureter because of the minimal invasiveness and the better cosmetic outcome compared to open surgery. Furthermore, our results showed that robotic-assisted reconstruction was technically easier, safer, and quicker compared to laparoscopic repair, and for these reasons, it should be preferentially adopted, when available.


Retrocaval ureter Robotics Laparoscopy Children Complications 


Author contributions

ME: project development, data collection, manuscript writing, and manuscript editing. LM: data collection, data analysis, and manuscript editing. JSV: data collection, data analysis, and manuscript editing. PJL: data collection, data analysis, and manuscript editing. BT: data collection, data analysis, and manuscript editing. IM: data collection, data analysis, and manuscript editing. CE: project development, data analysis, manuscript writing, and manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maria Escolino
    • 1
  • Lorenzo Masieri
    • 2
  • Jean-Stephane Valla
    • 3
  • Pedro Josè Lopez
    • 4
  • Baran Tokar
    • 5
  • Imran Mushtaq
    • 6
  • Ciro Esposito
    • 1
    Email author
  1. 1.Division of Pediatric Surgery“Federico II” University of NaplesNaplesItaly
  2. 2.Division of Pediatric UrologyMeyer Children HospitalFlorenceItaly
  3. 3.Division of Pediatric UrologyCHU LenvalNiceFrance
  4. 4.Division of Pediatric UrologyHospital Exequiel Gonzalez Cortes and Clinica AlemanaSantiagoChile
  5. 5.Division of Pediatric UrologyEskisehir Osmangazi UniversityEskisehirTurkey
  6. 6.Division of Pediatric UrologyGreat Ormond Street HospitalLondonUK

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