Single-port robot-assisted ureterolysis for retroperitoneal fibrosis: A less invasive path to functional recovery.

Abstract

Objective: The objective of this study is to evaluate the outcomes of an initial series of single-port robot-assisted ureterolysis (SP-RAU) in patients with retroperitoneal fibrosis (RPF).

Patients and methods: We prospectively collected surgical and clinical data from all consecutive patients undergoing SP-RAU at our institution between April 2016 and May 2024. The primary endpoint was the achievement of a stent-free status at 12 months.

Results: Overall, 16 patients (21 renal units) underwent SP-RAU with a minimum follow-up of 12 months. All five patients with bilateral disease were managed with a staged approach in two separate surgical sessions. RPF was idiopathic in 37% and secondary in 62% of cases. Four procedures (19%) were aborted due to extensive fibrosis or high vascular risk (one unilateral right, two unilateral left and one second-stage left unit). These patients had significantly longer preoperative stent duration (60 vs. 9 months; p = 0.006). Among the 17 completed procedures, no open conversions, intraoperative complications or transfusions occurred. Median operative time was 215 min (IQR 195-240), and median blood loss was 10 ml (IQR 10-20). Median length of stay was 11.5 h (IQR 7.8-26), with 52% of patients discharged the same day. At a median follow-up of 25 months (IQR 18-50), complete symptom resolution was achieved in 82% of renal units, whereas 64% remained stent-free at 12 months. The main limitations are the small sample size, single-surgeon experience and absence of a comparator arm.

Conclusion: SP-RAU is a safe and feasible minimally invasive option for managing RPF. It achieves good functional success with minimal morbidity and enables same-day discharge in over half of patients. Larger multicentre studies with longer follow-up are needed to confirm these findings and establish the role of SP-RAU in the management of RPF.