Single Port Robotic Extraperitoneal Distal Ureterectomy and Ureteral Reimplantation via Lower Anterior Approach

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First reports show reduced postoperative pain, fewer gastrointestinal complications and shorter hospital stay compared to multiport or open techniques ( 3 - 5 ). Recent experiences with robotic ureteral reconstruction have further supported the feasibility of advanced reconstructive procedures in selected patients ( 6 - 8 ) but literature on SP platform remains limited ( 9 , 10 ), therefore we present this innovative technique. Materials and Methods: We report the case of a 44-year-old female (BMI 29.1 kg/m 2 ), with medical history of fibromyalgia, who presented with right-sided back pain and nausea. CT-urogram showed severe right hydroureteronephrosis with a distal ureteral stricture and diffuse ureteral thickening, without a clear obstructing lesion. Diagnostic ureteroscopy revealed luminal narrowing due to wall thickening, without papillary masses. Biopsies and urine cytology were negative for urothelial carcinoma. A double-J stent was placed, and SP robotic distal ureterectomy with ureteral reimplantation was scheduled. Results: Low Anterior Access (LAA) was obtained through a 4-cm incision at the McBurney point. The retroperitoneal space was bluntly developed to identify the psoas muscle as anatomical landmark; the ureter was dissected caudally and resected at the level of the stricture. The bladder was then reached for cystotomy and ureteral reimplantation. Operative time was 160 minutes. No complications occurred and the patient was discharged on postoperative day 1. Final pathology revealed endometriosis. The ureteral stent was removed after 4 weeks; at 3-month follow-up the patient was asymptomatic, renal function was normal, and CT scan showed no right hydroureteronephrosis. Conclusion: Robotic SP extraperitoneal approach appears safe, feasible, and promising for ureteral reconstruction, combining retroperitoneal access with SP system dexterity and potentially reducing postoperative morbidity and hospital stay. Video 1 Available at: VIDEO Data Availability Data Not Provided REFERENCES 1 Lambertini L, Avesani G, Haberal HB, Torres Anguiano JR, Calvo RS, Morgantini L, et al. Single-port Robot-assisted Ureteral Reimplantation via Low Anterior Access: Step-by-step Procedure and Preliminary Comparative Results. Eur Urol Open Sci. 2025 Aug;78:51–8. doi:10.1016/j.euros.2025.06.002 » https://doi.org/10.1016/j.euros.2025.06.002 2 Orsini A, Lasorsa F, Bignante G, Yoon J, Dymanus KA, Cherullo EE, et al. Single Port Robotic Nephrectomy via lower anterior retroperitoneal approach: feasible, safe and effective option in surgically complex patients. Int Braz J Urol. 2024;50(6):785–6. doi:10.1590/S1677-5538.IBJU.2024.0420 » https://doi.org/10.1590/S1677-5538.IBJU.2024.0420 3 Ditonno F, Franco A, Licari LC, Bologna E, Manfredi C, Katz DO, et al. Implementation of single-port robotic urologic surgery: experience at a large academic center. J Robot Surg. 2024 Mar 16;18(1):119. doi:10.1007/s11701-024-01884-z » https://doi.org/10.1007/s11701-024-01884-z 4 Pulford C, Keating K, Rohloff M, Peifer D, Eames R, Maatman T. How we do it: robotic-assisted distal ureterectomy with ureteral reimplantation. Int Braz J Urol. 2021;47(6):1277–8. doi:10.1590/S1677-5538.IBJU.2021.0207 » https://doi.org/10.1590/S1677-5538.IBJU.2021.0207 5 Ditonno F, Franco A, Manfredi C, Chow AK, Vourganti S, Cherullo EE, et al. Single Port Robotic Pyeloplasty: early single-center experience. Int Braz J Urol. 2023;49(6):757–62. doi:10.1590/S1677-5538.IBJU.2023.0406 » https://doi.org/10.1590/S1677-5538.IBJU.2023.0406 6 Wang X, Meng C, Li D, Ying Y, Ma Y, Fan S, et al. Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes. Int Braz J Urol. 2024;50(1):46–57. doi:10.1590/S1677-5538.IBJU.2023.0393 » https://doi.org/10.1590/S1677-5538.IBJU.2023.0393 7 Amer-Mestre M, Tubau V, Guldris-García R, Rossello JB, Ayala EP. Laparoscopic onlay-flap ureteroplasty using cecal appendix. Int Braz J Urol. 2024;50(1):108–9. doi:10.1590/S1677-5538.IBJU.2023.0595 » https://doi.org/10.1590/S1677-5538.IBJU.2023.0595 8 Santa Cruz JAC, Danilovic A, Vicentini FC, Brito AH, Batagello CA, Marchini GS, et al. Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review. Int Braz J Urol. 2024;50(3):346–58. doi:10.1590/S1677-5538.IBJU.2024.9907 » https://doi.org/10.1590/S1677-5538.IBJU.2024.9907 9 Heo JE, Kang SK, Lee J, Koh D, Kim MS, Lee YS, et al. Outcomes of single-port robotic ureteral reconstruction using the da Vinci SP® system. Investig Clin Urol. 2023 Jul;64(4):373–9. doi:10.4111/icu.20230005 » https://doi.org/10.4111/icu.20230005 10 Santarelli V, Valenzi FM, Haberal HB, Morgantini LA, Biasatti A, Aljoulani M, et al. Current status of single port robotic-assisted reconstructive urology: a systematic review, meta-analysis and structured summary of the available literature. J Robot Surg. 2025 Jul 4;19(1):349. doi:10.1007/s11701-025-02509-9 » https://doi.org/10.1007/s11701-025-02509-9 Edited by Editor in Chief Luciano Alves Favorito Associate Editor Luciano Alves Favorito Publication Dates Publication in this collection 24 July 2026 Date of issue Jul-Aug 2026 History Received 09 Mar 2026 Accepted 12 Mar 2026 Published 15 Mar 2026 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Authorship .author-card { border-bottom: 1px solid #ccc; padding: 1rem 0; } .author-card:last-child { border-bottom: 0px; } .author-name { font-weight: 600; } .orcid-button { padding-left: 2.5rem; } .modal-body { padding-bottom: 3rem; } .orcid-button::before { content: ""; position: absolute; background-image: url(https://ds.scielo.org/img/logo-orcid.svg); background-repeat: no-repeat; background-size: 1.5em auto; background-position: .5em center; display: block; width: 60px; height: 60px; top: -10px; left: 0; } person Arianna Biasatti school Department of Medicine, Urological Clinic, Surgery and Health Sciences, University of Trieste, Trieste, Italy University of Trieste Italy Trieste, Italy Department of Medicine, Urological Clinic, Surgery and Health Sciences, University of Trieste, Trieste, Italy person Savio D. Pandolfo school Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy University of L’Aquila Italy L’Aquila, Italy Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy school Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II", Naples, Italy University of Naples "Federico II" Italy Naples, Italy Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II", Naples, Italy person Rocco Damiano school Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy Magna Graecia University of Catanzaro Italy Catanzaro, Italy Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy person Marco De Sio school Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy University of Campania "Luigi Vanvitelli" Italy Naples, Italy Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy person Ciro Imbimbo school Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II", Naples, Italy University of Naples "Federico II" Italy Naples, Italy Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II", Naples, Italy person Riccardo Autorino school Section of Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States Glickman Urological Institute United States Cleveland, OH, United States Section of Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States 0000-0001-7045-7725 person Correspondence address: Riccardo Autorino MD PhD Professor of Urology, Department of Urology Section of Robotic & Image guided Surgery Glickman Urological Institute Cleveland Clinic E-mail: [email protected] CONFLICT OF INTEREST None declared. Editor in Chief Luciano Alves Favorito Associate Editor Luciano Alves Favorito SCIMAGO INSTITUTIONS RANKINGS Department of Medicine, Urological Clinic, Surgery and Health Sciences, University of Trieste, Trieste, Italy University of Trieste Italy Trieste, Italy Department of Medicine, Urological Clinic, Surgery and Health Sciences, University of Trieste, Trieste, Italy Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy University of L’Aquila Italy L’Aquila, Italy Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II", Naples, Italy University of Naples "Federico II" Italy Naples, Italy Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples "Federico II", Naples, Italy Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy Magna Graecia University of Catanzaro Italy Catanzaro, Italy Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy University of Campania "Luigi Vanvitelli" Italy Naples, Italy Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy Section of Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States Glickman Urological Institute United States Cleveland, OH, United States Section of Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, United States How to cite link copy function currentDate() { var today = new Date(); var months = ['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'] today.setTime(today.getTime()); return today.getDate() + " " + months[today.getMonth()] + " " + today.getFullYear(); } var citation = 'Biasatti, Arianna et al. Single Port Robotic Extraperitoneal Distal Ureterectomy and Ureteral Reimplantation via Lower Anterior Approach. International braz j urol [online]. 2026, v. 52, n. 4 [Accessed CURRENTDATE], e20260151. Available from: . Epub 24 July 2026. 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