Introduction: The patient is a 35-year-old female with prior medical history of recurrent urinary tract infections (UTI), who presented to the emergency department for severe right abdominal pain with difficulty urinating. On physical exam, the patient was found to have a non-tender prolapsed ureterocele per urethra causing transient bladder outlet obstruction. Subsequent MRI of the pelvis showed severe right-sided hydroureter with ectopic insertion of the right ureter at the bladder neck and associated ureterocele, as well as moderate left-sided hydroureter with associated ureterocele. Here, we present a minimally invasive and definitive robotic repair of bilateral ureteroceles. Methods: The patient was prepped and draped in the usual sterile fashion. An anterior cystotomy measuring approximately 5 cm was made, and the bladder was emptied. A single port robotic access device was then placed directly into the bladder. The patient was placed in a slight Trendelenburg position and the robot was docked. Surgical footage highlights include: bilateral ureterocele excision using electrocautery, creation of a urothelial defect on the right ureter due to excision of the large ureterocele, ureteral re-approximation, and affixation of the ureter. The cystotomy was closed and the bladder was noted to be watertight. Results: Total operative time was 123 minutes. The patient recovered with unremarkable post-operative course and was discharged on same day of surgery. Post-operative imaging showed resolution of symptoms and bilateral hydronephrosis thereafter. Conclusions: Single-port transvesical approach provided a better vantage point for robotic repair compared to more traditional endoscopic approaches. This approach also allowed for the mucosa to be oversewn easily, mitigating risk of future stricture formation or ureterocele recurrence. In addition, higher insufflation pressure within bladder allowed ureteroceles to be collapsed, yet visible, and aided in excision. In summary, single-port robotic-assisted transvesical excision with ureteral re-approximation allowed for minimally invasive and definitive repair of bilateral ureteroceles. SOURCE OF Funding: None
