Robotic Ureterolysis with Omental Wrap

Robotic Surgery for Retroperitoneal Fibrosis (RPF)

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Retroperitoneal fibrosis (RPF) is an autoimmune disease that causes fibrotic scar tissue to form along the aorta and iliac arteries, very close to the ureter. Over time this scar tissue can grow around the ureter, blocking the flow of urine and causing it to back up into the kidneys. This disease typically occurs in people between the ages of 40 and 60, and affects men twice as often as women. Symptoms may include abdominal pain, swelling, pain or discoloration in one or both legs, and reduced urine flow. Left untreated, retroperitoneal fibrosis can cause kidney failure and other serious complications.

At NYU we have performed more robotic ureterolysis and omental wrap procedures then any other institution worldwide. Our standard approach is to obtain tissue for biopsy using robotics in order to confirm the diagnosis. The condition is first treated with anti-inflammatory and immunosuppressive drugs. If these fail to resolve the condition, then robotic uretolysis with omental wrap can be performed to surgically remove the scar tissue and restore urine flow—a process that includes repositioning the ureter away from the fibrosis and wrapping the omentum around the ureter to prevent obstruction from recurring.

How Robotic Ureterolysis with Omental Wrap is Performed

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In this procedure, the robot’s camera and instruments are inserted through several small incisions in the patient’s abdomen. The surgeon then proceeds to carefully carve through the scar tissue in order to release the ureter. Once the ureter is freed, the surgeon takes a portion of the omentum—the layer of fat that overlies the bowels—and wraps it around the ureter. This omental flap serves a double purpose: It increases blood flow to the ureter, helping it to function normally again; and it also forms a protective layer around the ureter, so that if new scar tissue forms it will grow around the fat layer without affecting the ureter.

Advantages of Robotic Ureterolysis with Omental Wrap

Less scarring and blood loss and faster recovery than open surgery. Robotic ureterolysis involves several small abdominal incisions rather than a single large incision, avoiding a large, disfiguring scar and shortening recovery time to 2 weeks—compared to 4 to 6 weeks for open surgery. In addition, the enhanced suturing capability of the da Vinci robot may result in less blood loss during surgery, reducing the need for blood transfusions.
Robotic surgery offers better precision and visualization than laparoscopy. This procedure is among the most complex of all surgeries, since it involves working around the ureter—a fragile tube just one-quarter inch in diameter—as well as other critical structures including the aorta and iliac arteries, the bowel, small bowel and colon. This requires precise cutting and delicate suturing with very fine suturing material. What is an extremely difficult procedure when done laparascopically, we believe becomes far easier when performed using the da Vinci’s precision controls and magnified, 3-D high definition view of the operating site. It has been our experience that robotics allows the operation to proceed more smoothly and quickly, while the surgery itself is done more precisely with minimal chance of missteps compared to standard laparoscopy.

Research by NYULMC Doctors on Robotic Ureterolysis with Omental Wrap

Meet Our Surgeons

To access the website for the Retroperitoneal Fibrosis World Support Group, an organization created by and for people with RPF and their families, click here.

Video Library

To watch videos of this procedure being performed by one of NYU Langone Medical
Center's robotic surgeons, click on the links below.