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

• Retroperitoneoscopic nephroureterectomy through low anterior access using the Da Vinci SP robot is an efficient, safe and often outpatient procedure with low. • Patient morbidity. • Patient selection is critical for success early in the learning curve as the Da Vinci SP approach is not ideal for very large volume specimens. • Low anterior access to the retroperitoneum is fast, reproducible and provides excellent exposure to the kidney and the entire ureter through a single incision. 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. 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. 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.