Robotic Buccal Mucosal Graft Ureteroplasty Melbourne
Robotic buccal mucosal graft ureteroplasty is an advanced reconstructive procedure used to repair complex or long ureteric strictures (narrowing of the ureter). When the strictured segment is too long for simple excision and re-anastomosis, or when the ureter cannot be reimplanted into the bladder, buccal mucosa (tissue from the inner cheek) is used as a graft to reconstruct the ureter. The da Vinci robotic surgical system enables this intricate procedure to be performed through small keyhole incisions with exceptional precision, offering patients faster recovery and excellent functional outcomes.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (Urology), DrNB (Urology), FRCS (Urol), FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Minimally invasive robotic approach with 5-6 small incisions
- Enhanced precision for delicate ureteric reconstruction
- Preserves kidney function by restoring urine drainage
- Avoids need for permanent nephrostomy tubes
- Buccal mucosa is an ideal graft with high success rates
- Shorter hospital stay compared to open surgery
- Faster return to normal activities
- Excellent long-term patency rates
The Procedure
The procedure is performed under general anaesthesia and typically takes 3-4 hours. A buccal mucosal graft is first harvested from the inner cheek through a small incision in the mouth. The patient is then repositioned and 5-6 small abdominal incisions are made for the robotic instruments. The strictured ureter is identified and opened along its length. The buccal mucosal graft is shaped and sutured to the opened ureter to widen the narrowed segment (onlay technique) or used to create a tubularised replacement segment. A ureteric stent is placed to allow healing. The graft site in the mouth is left open to heal by secondary intention.
Who Is a Candidate?
Robotic buccal mucosal graft ureteroplasty may be recommended for long ureteric strictures (typically >3-4cm), strictures in the upper or mid ureter not amenable to reimplantation, failed previous ureteric surgery or endoscopic treatment, strictures from radiation therapy, strictures associated with retroperitoneal fibrosis, patients wishing to avoid permanent nephrostomy drainage, and those seeking kidney preservation when nephrectomy might otherwise be considered.
Recovery
Most patients are discharged within 2-4 days. A ureteric stent remains in place for 4-6 weeks to support healing and is removed as an outpatient procedure. The mouth heals within 1-2 weeks; some temporary numbness or tightness is normal and resolves. Light activities can resume from week 1. Avoid heavy lifting for 4-6 weeks. Return to office work at 2-3 weeks, manual work at 4-6 weeks. Follow-up imaging (CT or ultrasound) is performed after stent removal to confirm success. Long-term surveillance monitors for stricture recurrence.
Risks & Considerations
Potential complications include bleeding, infection, and anaesthetic risks. Specific risks include graft failure or stricture recurrence (10-15%), urine leak requiring prolonged stent drainage, stent-related discomfort or infection, injury to surrounding structures, conversion to open surgery if needed, and oral complications including temporary numbness, tightness, or altered sensation at the graft harvest site (usually temporary). Dr Dias will discuss how these risks apply to your specific situation during consultation.