Single-port retroperitoneal robotic pyeloplasty: Description of technique

We are presenting a novel technique to perform single-port (SP) extraperitoneal dismembered pyeloplasty using a modified mini-Pfannenstiel incision. Our case is a 31 year-old female with history of right sided flank pain and recurrent urinary tract infections. Her flank pain required consistent use of analgesic medication. Preoperative MAG-3 scan demonstrated 30% function of the right kidney and there was no response to furosemide administration on the right side. Patient underwent right ureteral J stent placement prior to referral and her pain improved significantly with ureteral stent placement. The decision was made to treat the patient with SP extraperitoneal right robotic dismembered pyeloplasty. The access was made through a 3.5 cm modified Pfannenstiel incision and with blunt dissection, the extraperitoneal space was created. Da Vinci SP access kit was used to insert an 8 mm assistant port, and the remotely operated suction irrigation system was used. After access, surgical steps in order were 1) Ureteral Dissection, 2) Renal pelvis dissection, 3) Excision of strictured segment, 4) Spatulation of ureter and pelvis, 5) Anastomosis. Surgery was completed successfully without any need for additional port placement. Operative time was 175 minutes and estimated blood loss was 20 ml. Patient was discharged home the day of surgery. She did not require opioid analgesics after discharge. Ureteral J stent was removed 4 weeks after surgery and the patient has been without right flank pain since ureteral stent removal. Postoperative MAG-3 scan showed resolution of obstruction. Retroperitoneal SP dismembered pyeloplasty is safe and feasible using a modified mini-Pfannenstiel incision. This approach is applicable to any patient without a past history of pelvic surgery.