Ureteroneocystostomy for Ureteral Endometriosis Using the da Vinci SP

OBJECTIVE: Ureteroneocystostomy should be considered in cases of severe ureteral endometriosis when ureteral lesions are near the bladder insertion, or the lesions involve the ureteral wall along a large extent of the pelvic ureter, making end-to-end anastomosis is not feasible [1,2]. The objective of this video is to demonstrate the technical and anatomical highlights of ureteroneocystostomy for ureteral endometriosis using the da Vinci SP (SP). SETTING: An urban general hospital. Stepwise demonstration of the technique with narrated video footage. PARTICIPANTS: A 49-year-old woman presented with chronic pelvic and back pain. Magnetic resonance imaging and urography revealed uterine fibroids, left hydroureter, and grade 4 hydronephrosis with ureteral endometriosis. Although serum creatinine levels were within the normal range (0.76 mg/dL), a renogram confirmed residual left kidney function of only 20%. INTERVENTIONS: We performed robot-assisted ureteroneocystostomy with hysterectomy using SP. The surgical steps were completely identical to conventional multiport laparoscopic robotic surgery [3,4]. Meticulous dissection, suturing, and knot-tying have been challenges in conventional single-port laparoscopic surgery, but with this new robot, such procedures become easy with the articulating instruments. The surgery was completed without any complications. The total operative time was 165 min, and the estimated blood loss was 10 mL. The postoperative course was uneventful. Intrinsic-type ureteral endometriosis was confirmed pathologically. Follow-up computed tomography at 6 months postoperatively revealed no hydronephrosis or hydroureter. The patient did not require any further surgery and was very satisfied with the invisible operative scar. The patient is still under observation for renal function and recurrence. CONCLUSION: Ureteroneocystostomy for ureteral endometriosis using SP is technically feasible with good cosmesis. To the best of our knowledge, this is the first report of single-port laparoscopic surgery for ureteroneocystostomy in the field of gynecology.