Idiopathic Retroperitoneal Fibrosis (RPF) is a rare, chronic, and progressive disorder with an unknown but estimated annual incidence of 1.3/100k people. RPF can cause ureteral obstruction and impair renal function, requiring medical therapy and renal decompression – sometimes in the form of ureterolysis. Ureterolysis has been described with open, laparoscopic, and multiport robotic techniques. In continuing to apply new surgical techniques and technology to treat this uncommon disease, this report seeks to assess the safety and feasibility of a single port robotic platform for a small consecutive series of patients who underwent single port robotic ureterolysis (SPU) to treat ureteral obstruction caused by RPF.

Between November 2019 and February 2021, data were collected on all cases of ureterolysis using the SP performed at a single institution by a single surgeon. Patient demographic, pre-, peri-, and post- operative data were retrospectively collected for key outcomes. This study has been approved by the University of Illinois at Chicago Institutional Review Board.

During the study interval, 7 cases (5 patients) of SPU were performed. 2 cases (1 patient) with concurrent pyeloplasty were excluded from this analysis. The average follow-up was 238 days (7-442). Table 1 displays perioperative data. 3 of 4 (75%) patients were discharged on the same day of surgery; the average length of stay was 0.6 days. There were no intraoperative complications, re-admissions, or required additional interventions. All patients are symptom free. No patients are currently on medication. 4 of 5 (80%) cases and 3 of 4 (75%) patients are stent free and with radiographic evidence of stable/improved hydronephrosis. The case and patient with a stent in place had SPU performed recently, thus without an adequate length of follow up and has a stent in place per protocol with scheduled assessment and follow up imaging.

This study demonstrates the feasibility of single port robotic ureterolysis with favorable outcomes in our study population.

Single port robotic ureterolysis is a feasible and safe procedure and opens the door to same day surgery for definitive treatment of ureteral obstructions. The functional outcomes during our follow up period are encouraging. As we continue to develop and apply new technology and methods to treat this disease, single port robotic ureterolysis should be included in future studies and comparisons to delineate its role. 
Future studies on this innovative surgical procedure are therefore suggested in order to establish it as valid treatment alternative in patients with Idiopathic Retroperitoneal Fibrosis.