First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff : a step-by-step technique

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.