JOURNAL OF ENDOUROLOGY Volume 22, Number 8, August 2008 © Mary Ann Liebert, Inc. Pp. 1669–1675 DOI: 10.1089/end.2008.0034 Robot-Assisted Ureterolysis, Retroperitoneal Biopsy, and Omental Wrap: Pilot Series for the Treatment of Idiopathic Retroperitoneal Fibrosis Patrick W. Mufarrij, M.D., Michael E. Lipkin, M.D., and Michael D. Stifelman, M.D. Abstract Background and Purpose: Retroperitoneal fibrosis (RPF) is an uncommon disease of vague cause distinguished by a chronic inflammatory response. Traditionally, RPF with ureteral involvement has been managed with open ureterolysis and transposition, with excellent success rates. More recently, laparoscopic ureterolysis has been described. Here, we report our experience of managing idiopathic RPF with robot-assisted ureterolysis, retroperitoneal biopsy, and ureteral omental wrapping. Patients and Methods: We performed robot-assisted ureterolysis, retroperitoneal biopsy, and ureteral omental wrapping on five consecutive patients between April and October 2006. The same technique was used for all five patients, except for the omental wrapping. Initially, omental wrapping was performed laparoscopically, but in the last two patients, it was performed entirely robotically. We analyzed our patients’ data retrospec- tively. Results: The mean operative time was 220.5 minutes and 390 minutes for unilateral and bilateral cases, re- spectively; mean blood loss 33.4 mL; mean length of stay 2.8 days; and mean follow-up was 5.6 months. All patients have remained free of obstruction since surgery and no longer need pain medication. Conclusions: Our study suggests that robot-assisted ureterolysis with laparoscopic or robot-assisted omental wrapping is a feasible alternative to the more morbid open procedure and compares favorably to the purely laparoscopic technique with respect to operative times, estimated blood loss, length of stay, and postoperative relief of obstruction. This procedure can be performed entirely robotically, which provided several advantages over the other techniques. 1669 Introduction R ETROPERITONEAL FIBROSIS (RPF) is an uncommon disease that was first described in 1906 by Albarran, 1 and then disseminated in 1948 by Ormond’s communication in the En- glish literature. 2 The disease is distinguished by chronic in- flammation in the retroperitoneum that may entangle any nearby structures, especially the ureters, aorta, and vena cava. While its incidence is unclear, estimates range from one case per 200,000 to 500,000 persons per year. 3,4 RPF mainly affects men in their fifth and sixth decades of life, with a 3:1 male to female ratio, but no ethnic predisposition. 5,6 RPF can be categorized as idiopathic (60%–70% of cases) or as sec- ondary, which can have numerous causes. The initial management depends on the level of renal im- pairment, extent of disease, and the need for multiple deep- tissue biopsies. Traditionally, RPF with ureteral involvement has been managed with open ureterolysis and transposition, with excellent success rates. 7–9 More recently, laparoscopic ureterolysis has been described. 6,10,11 Previously, we reported our first case of robot-assisted ureterolysis, retroperitoneal biopsy, and laparoscopic omen- tal ureteral wrapping for the management of ureteral ob- struction from RPF. 12 Here, we present our technique and data from our first five patients. Materials and Methods Between April and October of 2006, five patients under- went robot-assisted ureterolysis, retroperitoneal biopsy, and omental wrapping. All gave informed consent for the above procedure in addition to “possible neoureterocystotomy, Department of Urology, New York University Medical Center, New York, New York.