Robot-Assisted Ureterolysis, Retroperitoneal Biopsy, and Omental Wrap: Pilot Series for the Treatment of Idiopathic Retroperitoneal Fibrosis

Abstract

Retroperitoneal fibrosis (RPF) is an uncommon disease of vague cause distinguished by a chronic inflammatory response. Traditionally, RPF with ureteral involvement has been managed with open ureterolysis and transposition, with excellent success rates. More recently, laparoscopic ureterolysis has been described. Here, we report our experience of managing idiopathic RPF with robot-assisted ureterolysis, retroperitoneal biopsy, and ureteral omental wrapping. We performed robot-assisted ureterolysis, retroperitoneal biopsy, and ureteral omental wrapping on five consecutive patients between April and October 2006. The same technique was used for all five patients, except for the omental wrapping. Initially, omental wrapping was performed laparoscopically, but in the last two patients, it was performed entirely robotically. We analyzed our patients' data retrospectively. The mean operative time was 220.5 minutes and 390 minutes for unilateral and bilateral cases, respectively; mean blood loss 33.4 mL; mean length of stay 2.8 days; and mean follow-up was 5.6 months. All patients have remained free of obstruction since surgery and no longer need pain medication. Our study suggests that robot-assisted ureterolysis with laparoscopic or robot-assisted omental wrapping is a feasible alternative to the more morbid open procedure and compares favorably to the purely laparoscopic technique with respect to operative times, estimated blood loss, length of stay, and postoperative relief of obstruction. This procedure can be performed entirely robotically, which provided several advantages over the other techniques.