From cheek to ureter: initial experience and learning curve of single-port robotic buccal mucosa graft ureteroplasty for complex strictures

To evaluate the initial experience of single-port robot-assisted ureteral reconstruction using a buccal mucosa graft and assess the preliminary learning curve associated with this technique. A retrospective analysis was conducted on 20 consecutive patients who underwent single-port robot-assisted ureteroplasty with buccal mucosa grafts between January 2020 and January 2026. Perioperative parameters, complications, and follow-up outcomes were recorded. Restenosis-free survival was estimated using the Kaplan-Meier method, and the learning curve for operative time was analyzed using the cumulative sum (CUSUM) method. All procedures were completed without conversion. The median follow-up period was 4.5 months (range, 1-12). The overall success rate was 90% (18/20), with two patients developing restenosis at 4 and 7 months postoperatively, requiring reintervention. The 30-day complication rate was 20% (4/20), including one Clavien grade II and three grade IIIa complications. Long-term complications occurred in two patients (10%). CUSUM analysis demonstrated a notable decline in operative time after approximately 10 cases, with stabilization after 17 cases. Single-port robot-assisted ureteroplasty with buccal mucosa grafting appears to be a safe and effective minimally invasive option for complex ureteral strictures, with favorable initial experience and an acceptable learning curve. Larger prospective studies with extended follow-up are required to confirm the long-term efficacy.