Robotic ureterolysis, retroperitoneal biopsy, and omental wrap for the treatment of ureteral obstruction due to idiopathic retroperitoneal fibrosis

Abstract

Retroperitoneal fibrosis (RPF) is a rare disorder of unclear etiology characterized by chronic inflammation of the retroperitoneum, which can involve any of the retroperitoneal structures, most notably the ureters, aorta, and vena cava. Historically, open biopsy, ureterolysis, and transpositioning or omental wrapping of the involved ureter(s) have been the preferred surgical treatments of RPF, with success rates greater than 90%. More recently, successful laparoscopic biopsy, ureterolysis, and ureteral omental wrapping and intraperi-tonealization have been described. We report the first case in the literature of idiopathic RPF managed with robotic ureterolysis and laparoscopic omental ureteral wrapping.

Figure 1

Computed tomography scan performed at initial presentation shows a large mass surrounding the aorta, as well as hydronephrosis of the right kidney and a delayed right nephrogram.

Figure 2

Cystoscopy and retrograde pyelography reveal a 2.5-cm narrowing of the mid-ureter, just above the level of the iliac vessels.

Figure 3

For robotic and laparoscopic surgery, a 12-mm trocar and 2 robotic trocars were placed in a wide “V” configuration; 2 assistant trocars (12 mm and 5 mm) were placed in the midline above the camera port.

Figure 4

Final pathologic evaluation demonstrated dense fibrotic tissue with chronic inflammation.

Figure 5

Two months postoperatively, CT scan shows resolution of the right hydronephrosis, no evidence of obstruction, and a lateralized right ureter.