Single Port Robotic Extraperitoneal Excision of Ureteral Remnant with Ureterocele Resection

Abstract

Introduction and Objective:

A 30-year-old female patient with history of a right ureterocele and right upper pole heminephrectomy for recurrent infections continued to have right flank pain and recurrent urinary tracts infections. She was found to have continued reflux and hydroureter of the upper pole moiety ureter on workup and presented for a single port robotic extraperitoneal excision of the ureteral remnant.

Methods:

A single port robotic extraperitoneal excision of the ureteral remnant of the right upper pole moiety was performed with the da Vinci SP^® robotic system. A 4 cm transverse lower anterior retroperitoneal access (LARA) incision was made at the McBurney’s point. The peritoneum was bluntly dissected away, and the single port robot was docked extraperitoneally. The right upper pole moiety ureter remnant was localized by performing a simultaneous ureteroscopy while using the Firefly mode and TilePro function. The right upper pole ureter was dissected away from the lower pole moiety ureter and divided at the level of the bladder. The ureterocele was cauterized and sutured closed. Closure was confirmed to be watertight.

Results:

The operative time of the single port robotic re-revision of ureteroenteric anastomosis (UEA) was 140 minutes with 90 minutes of console time. There was 20 mL of blood loss. Foley catheter removed on postoperative day 5. Three months postoperatively, she has not had right flank pain or recurrence of a urinary tract infection.

Conclusion:

The ureteral remnant may be a source of infection due to reflux and urinary stasis. The single port robot allows for removal of this remnant while remaining extraperitoneal. Ureteroscopy while using the TilePro setting and Firefly mode can facilitate identifying the ureter especially in the scenario of a completely duplicated system.

Source of Funding

: None.

Runtime of video

: 8 min and 8 sec.

Conflict of Interest and Disclosure Statement

: Dr. Sammy E Elsamra: Intuitive Surgical (Consultant).

All authors have received and archived patient consent for video recording and publication in advance of video recording of procedure.

There are no further disclosures from the other authors.

Topic List

: Reconstruction.