V904: Bilateral Laparoscopic Ureterolysis and Bilateral Robot Assisted Psoas Hitch with Ureteral Reimplantation for Pelvic Idiopathic Retroperitoneal Fibrosis

Video

Introduction and Objectives
Retroperitoneal fibrosis (RPF) is a chronic and progressive disease that consists of an inflammatory and fibrotic process of the retroperitoneum that can cause compression of vital organs including the ureters leading to significant hydronephrosis. The majority of cases are deemed idiopathic. Standard therapy of idiopathic RPF includes renal decompression and medical management with steroids or immune modulaters. Ureterolysis may be required for relief of obstruction. In this video we demonstrate a case in which a 60 year old female with idiopathic RPF who underwent bilateral laparoscopic ureterolysis and bilateral robot assisted psoas hitch with ureteral reimplantation.

Methods
The patient was taken to the operating room for bilateral laparoscopic ureterolysis and bilateral robot assisted psoas hitch with ureteral reimplantation. The operation was performed utilizing low lithotomy with Trendenlenburg positioning. After mobilization of colon, extensive bilateral ureterolysis was performed down to the level of the iliac vessels. Multiple biopsies were performed to rule out a malignant cause for the RPF. Following the ureterolysis, the da Vinci surgical system was used to perform a bilateral psoas hitch and ureteral reimplantation.

Results
The use of minimally invasive techniques allowed for a successful bilateral ureterolysis and psoas hitch with reimplantation to be performed in a single session.

Conclusions
The treatment for RPF can be safe and effective through a minimally invasive approach. This approach allowed for bilateral ureterolysis, psoas hitch, and reimplantation to be performed in a single session.

Funding: none