Introduction: Reconstruction of the upper urinary tract can be challenging and complex. The introduction of new technology and techniques has had a profound impact on how urologists approach these cases. This video demonstrates a unique anterior retroperitoneal approach using a single port robotic platform to treat a distal ureteral stricture, although this approach can be used for any upper urinary tract reconstructive surgery as well. Methods: In this video demonstration, we describe an anterior retroperitoneal approach using the da Vinci SP robotic platform to treat a right-sided 3 cm long distal ureteral stricture with a psoas hitch and reimplantation. The patient is a twenty-nine-year-old female with a history of cesarean section, tubal ligation, multiple endoscopic treatments of urolithiasis, and a right ureteral balloon dilation complicated by perforation at an outside institution. The patient is positioned supine with open arms, and McBurney’s point (or its equivalent on the left side) identifies how lateral the incision should be made. The incision can be adjusted in the cranial or caudal direction depending on which part of the upper urinary tract the surgery will be performed. After incising the fascia, the peritoneum is bluntly dissected away from the transversalis fascia until the psoas is palpated and there is adequate room to place the SP access port and continue the surgery. Results: We successfully performed a salvage right sided ureteral reimplant with psoas hitch using this approach to treat the distal ureteral stricture. One small hole was inadvertently created in the peritoneum, and we briefly discuss strategies to manage this. The patient was discharged day of surgery with a foley catheter and ureteral stent and followed an unremarkable post-operative course. The ureteral stent was removed in clinic 4 weeks later and she is scheduled for imaging follow up per protocol. Conclusions: An anterior retroperitoneal approach using a single port robotic platform can be performed during upper urinary tract reconstructive surgeries and offers several advantages. SOURCE OF Funding: None
