# Preventing rare contralateral ureteral injury during robotic-assisted nephroureterectomy: lessons from a surgical complication

## TL;DR

A rare case of contralateral ureteral injury during robotic surgery is reported, emphasizing the need for careful planning and vigilance to prevent such complications.

## Contribution

The paper presents a novel case report and lessons learned to improve surgical safety in robotic-assisted nephroureterectomy.

## Key findings

- Anatomical distortion during surgery led to misplacement of a clip, causing ureteral obstruction.
- Urgent cystoscopy and ureteroneocystostomy restored ureteral function.
- Thorough preoperative planning and intraoperative vigilance are critical to prevent rare complications.

## Abstract

Robotic-assisted laparoscopic nephroureterectomy (RALN) is a common approach for upper tract urothelial carcinoma (UTUC), offering advantages such as reduced morbidity and improved recovery. However, contralateral ureteral injury during bladder cuff excision is extremely rare and can be challenging to manage. We present the case of a 56-year-old male with low-grade urothelial carcinoma of the right renal pelvis who underwent RALN. Anatomical distortion during surgery led to misplacement of a surgical clip at the contralateral ureterovesical junction, resulting in obstruction and anuria. Urgent cystoscopy and ureteroneocystostomy with stent placement successfully restored ureteral function. This case highlights the importance of thorough preoperative planning, careful anatomical verification, and heightened intraoperative vigilance to prevent such rare complications in robotic surgery. Ensuring accurate identification of anatomical structures is crucial to avoid inadvertent injury, specifically in complex urologic oncology procedures.