Tubo-ovarian Deflection During Robotic Ureteral Reimplantation for Vesicoureteral Reflux in Girls

OBJECTIVE: To evaluate the feasibility, safety, and outcomes of medial tubo-ovarian deflection (MTOD), a maneuver involving division of the round ligament to enhance distal ureteral access, compared with standard robotic-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV), in female children with vesicoureteral reflux. METHODS: We reviewed female patients who underwent RALUR-EV for primary vesicoureteral reflux (VUR) from 2017 to 2025, dividing into Control (2017-2020) and MTOD (2021-2025) groups. We compared operative metrics, complications, and radiographic outcomes and used multivariable regression to assess MTOD's effect on operative time. RESULTS: Thirty-five patients were included (MTOD: n = 11; Control: n = 24). Ipsilateral VUR grades were similar between cohorts (P = .331). MTOD was feasible and performed in all cases. Operative time was shorter in the MTOD group (80 vs 120 minutes, P = .031). In multivariable regression, MTOD was identified as a predictor of shorter operative time (β = (-45), 95% CI [-88, -2.5], P = .047). No cases of high-grade persistent VUR (grades III-V) occurred in either group. No cases of de novo reflux were observed in the MTOD group. CONCLUSION: MTOD is a safe, feasible, and reproducible adjunct maneuver that enhances distal ureteral exposure during RALUR-EV in female children and is associated with shorter operative time.