Robotic Local Fat Extirpation and Ureteric Reimplantation for Pelvic Lipomatosis with Ureteric Obstruction: Technical Considerations

BACKGROUND: Ureteric reimplantation is the treatment of choice for pelvic lipomatosis with ureteric obstruction. Pelvic adherent fat poses a technical challenge during this surgery. DESCRIPTION OF TECHNIQUE: We describe the robotic approach to facilitate the precise dissection of the ureter and bladder in adherent fat. After creating pneumoperitoneum and port placement, the ureter is exposed at the iliac crossing and dissected distally. Perivesical fat at the intended site of ureteric reimplantation is excised and cystotomy is done. Ureterovesical anastomosis is performed over a stent. PATIENTS AND METHODS: Two patients with pelvic lipomatosis causing ureteric obstruction and renal function impairment underwent robotic ureteric reimplantation at our institute. Technical aspects and outcomes are discussed here. RESULTS: Blood loss was minimal. No intra-operative or post-operative complication was noted. Renal function improved for both patients. CONCLUSION: Robotic approach helps to overcome the technical difficulties posed by adherent fat during ureteric reimplantation in pelvic lipomatosis.