Comparison of three port placement strategies for Robot-Assisted Laparoscopic Lich-Gregoir Direct Nipple Ureteral Extravesical Reimplantation in Pediatric Primary Obstructive Megaureter : Multi-ports,Single-port-plus-one,Single-port

Yuru ZhangJingjing LuShan LinShaohua HeDi Xu^*Jianglong Chen^*

• Fujian Provincial Hospital, Fuzhou, China

Objective: This study aimed to evaluate the efficacy, safety, and cosmetic outcomes of three robot-assisted laparoscopic techniques for treating pediatric primary obstructive megaureter (POM): robot-assisted laparoscopic multi-ports (RLMG), robot-assisted laparoscopic single-port-plus-one (RLSPG), and robot-assisted laparoscopic single-port (RLSG). Materials and methods: A retrospective analysis included 30 pediatric POM patients (December 2022 – December 2024) undergoing Da Vinci Xi robotic Lich-Gregoir ureteral reimplantation. Patients were categorized into RLMG (n=13), RLSPG (n=10), and RLSG (n=7) groups based on incision methods. Preoperative assessments, Intraoperative parameters , postoperative outcomes, and hydronephrosis metrics were analyzed using SPSS 21.0, with significance set at P<0.05. Results:There were no significant differences in baseline demographic characteristics.There were significant inter group differences in the distribution of surgical side (P=0.005). In terms of total surgical time, the RLMG group was significantly shorter than the RLSPG and RLSG (P=0.02). There was no significant difference in ureteral reimplantation time among the three groups (P=0.85), but the ratio of ureteral reimplantation time to total surgical time in the RLSPG and RLSG was significantly lower than that in the RLMG (P<0.001). The Stony Brook Scar Evaluation Scale (SBSES) score showed that the RLSG had significantly higher scores than the RLMG (P=0.009) and RLSPG (P=0.244). After surgery, only 2 cases of RLMG, 3 cases of RLSPG, and 2 cases of RLSG developed urinary tract infections, all of which were relieved through conservative treatment without recurrence. In terms of follow-up time, the RLMG had the longest median follow-up time, with significant differences between groups (P<0.001). The relief rate of obstruction in all three groups was 100%. Postoperative renal hydronephrosis parameters were significantly improved compared to preoperative levels (P<0.001). Conclusion: Robot-assisted laparoscopic ureteral reimplantation is a safe and effective treatment for pediatric POM. The single-port approach achieves superior cosmesis, whereas the multi-ports technique affords the shortest operative time. The single-port-plus-one offers a balanced intermediate option, enabling surgeons to optimize outcomes based on patient and procedural needs.