Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection

Introduction: The Da Vinci single port (SP) robotic system has emerged as a valuable platform for minimally invasive urologic surgery in the past decade. While adoption has been growing rapidly for procedures such as pyeloplasty, partial nephrectomy and radical/simple prostatectomy, its application...

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Main Authors: Benjamin Yu, Richard E. Link
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Urology Video Journal
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Online Access:http://www.sciencedirect.com/science/article/pii/S259008972500009X
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author Benjamin Yu
Richard E. Link
author_facet Benjamin Yu
Richard E. Link
author_sort Benjamin Yu
collection DOAJ
description Introduction: The Da Vinci single port (SP) robotic system has emerged as a valuable platform for minimally invasive urologic surgery in the past decade. While adoption has been growing rapidly for procedures such as pyeloplasty, partial nephrectomy and radical/simple prostatectomy, its application to retroperitoneal nephroureterectomy has been less thoroughly explored. Here, we describe a retroperitoneoscopic approach to a simple nephroureterectomy using the Da Vinci SP robot and low anterior access. We focus on patient selection, advantages of regionalized SP surgery, and technical tips for operative efficiency and safety. Patient Case: Our patient is a 62-year-old female with recurrent urinary tract infections, chronic right flank pain, severe right hydroureteronephrosis and renal atrophy secondary to a chronically obstructing ureteral stone. Using a low anterior retroperitoneal SP approach, we were able to navigate complex hilar anatomy and perform a simple nephroureterectomy. The patient had no intraoperative complications and an excellent post-operative recovery. Discussion: Proper patient selection is crucial to the success of the retroperitoneal SP approach. The SP system is ideally suited for confined retroperitoneal spaces and smaller specimens, enabling efficient nephroureterectomy through a single incision with reduced patient morbidity. While the SP platform has some limitations, such as fewer available instruments and reduced retraction strength, its advantages in well-selected cases include easier and reproducible access to the renal anatomy, decreased operative time, reduced hospital stays, and improved recovery. This case illustrates the potential for single-port retroperitoneal nephroureterectomy as a minimally invasive alternative to traditional multiport or transperitoneal approaches.
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spelling doaj-art-3859ae8d4bcc4b7b94b2a2e7e41bf8942025-08-20T01:52:12ZengElsevierUrology Video Journal2590-08972025-06-012610033310.1016/j.urolvj.2025.100333Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selectionBenjamin Yu0Richard E. Link1Baylor College of Medicine, Scott Department of Urology, USACorresponding author at: Professor of Urology, Carlton-Smith Endowed Chair in Urologic Education, Director, Division of Endourology and Minimally Invasive Surgery, 7200 Cambridge St., Ste 10B, Houston, TX, 77030 USA.; Baylor College of Medicine, Scott Department of Urology, USAIntroduction: The Da Vinci single port (SP) robotic system has emerged as a valuable platform for minimally invasive urologic surgery in the past decade. While adoption has been growing rapidly for procedures such as pyeloplasty, partial nephrectomy and radical/simple prostatectomy, its application to retroperitoneal nephroureterectomy has been less thoroughly explored. Here, we describe a retroperitoneoscopic approach to a simple nephroureterectomy using the Da Vinci SP robot and low anterior access. We focus on patient selection, advantages of regionalized SP surgery, and technical tips for operative efficiency and safety. Patient Case: Our patient is a 62-year-old female with recurrent urinary tract infections, chronic right flank pain, severe right hydroureteronephrosis and renal atrophy secondary to a chronically obstructing ureteral stone. Using a low anterior retroperitoneal SP approach, we were able to navigate complex hilar anatomy and perform a simple nephroureterectomy. The patient had no intraoperative complications and an excellent post-operative recovery. Discussion: Proper patient selection is crucial to the success of the retroperitoneal SP approach. The SP system is ideally suited for confined retroperitoneal spaces and smaller specimens, enabling efficient nephroureterectomy through a single incision with reduced patient morbidity. While the SP platform has some limitations, such as fewer available instruments and reduced retraction strength, its advantages in well-selected cases include easier and reproducible access to the renal anatomy, decreased operative time, reduced hospital stays, and improved recovery. This case illustrates the potential for single-port retroperitoneal nephroureterectomy as a minimally invasive alternative to traditional multiport or transperitoneal approaches.http://www.sciencedirect.com/science/article/pii/S259008972500009XRobotic surgerySingle port roboticsNephroureterectomyKidneyMinimally Invasive Surgery
spellingShingle Benjamin Yu
Richard E. Link
Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection
Urology Video Journal
Robotic surgery
Single port robotics
Nephroureterectomy
Kidney
Minimally Invasive Surgery
title Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection
title_full Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection
title_fullStr Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection
title_full_unstemmed Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection
title_short Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection
title_sort single port robotic retroperitoneoscopic nephroureterectomy technical approach and recommendations for patient selection
topic Robotic surgery
Single port robotics
Nephroureterectomy
Kidney
Minimally Invasive Surgery
url http://www.sciencedirect.com/science/article/pii/S259008972500009X
work_keys_str_mv AT benjaminyu singleportroboticretroperitoneoscopicnephroureterectomytechnicalapproachandrecommendationsforpatientselection
AT richardelink singleportroboticretroperitoneoscopicnephroureterectomytechnicalapproachandrecommendationsforpatientselection