First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff : a step-by-step technique
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Abstract
Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper
tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuf has never been
reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique
allowing to perform robot-assisted NU by a unique retroperitoneal approach.
Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely
restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical
robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed.
Results The analysis included fve patients [median age: 73 years; BMI: 27.2 kg/m2
; Charlson comorbidity index 5]. All fve
patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to
kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade].
Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding
EAUiaiC classifcation≥2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postopera tive complications exceeding Clavien–Dindo classifcation≥3a. Median hospital stay was 5.4d without any 30-d readmission.
Conclusion We demonstrate safety and feasibility of the frst entire robot-assisted retroperitoneal nephroureterectomy
(RRNU) with bladder cuf. This surgical technique is easily reproducible, while surgical outcomes are similar to other
established techniques.
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World journal of urology, 40, 1019, Springer, Berlin u.a., 2022, https://doi.org/10.1007/s00345-021-03920-1