Robotics and Laparoscopy
Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series
Article first published online: 23 JUL 2013
© 2013 BJU International
Volume 112, Issue 4, pages E295–E300, August 2013
How to Cite
Pugh, J., Parekattil, S., Willis, D., Stifelman, M., Hemal, A. and Su, L.-M. (2013), Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series. BJU International, 112: E295–E300. doi: 10.1111/bju.12163
- Issue published online: 23 JUL 2013
- Article first published online: 23 JUL 2013
- urothelial carcinoma;
- robotic surgery
- To review a multi-institutional series of robot-assisted nephroureterectomy (RANU) for management of upper urinary tract urothelial carcinoma (UUTUC) with respect to technique and perioperative outcomes.
Patients and Methods
- Between May 2007 and July 2011, 43 RANU were performed at three institutions for UUTUC with review of perioperative outcomes.
- A three- or four-armed robotic technique was used in all cases based on surgeon preference and the entirety of all procedures was performed using the robot-assisted technique.
- Single and two robot-docking techniques are described.
- The mean (range) operating time was 247 (128–390) min, blood loss was 131 (10–500) mL and the median (range) length of stay was 3 (2–87) days.
- Pathology was pTa in nine patients, pT1 in 14 patients, pT2 in three patients, pT3 in 15 patients and pT4 in two patients.
- Lymph node dissection was performed in 22 patients (51%) with a mean (range) lymph node count of 11 (4–23).
- There were six postoperative complications: bleeding requiring a blood transfusion (grade II), splenic bleeding (grade IV), two cases of pneumonia (grade II) and two cases of rhabdomyolysis (grades II and IV).
- Nine recurrences (six bladder, two within the retroperitoneum and one in the contralateral collecting system) have been found to date on routine surveillance with a mean follow-up of 9 months.
- RANU is a feasible alternative to laparoscopic and open techniques.
- Particular steps of the operation including sutured closure of the cystotomy and regional lymphadenectomy are facilitated with the use of robot-assisted surgery.
- Long-term outcomes are necessary to assess the relative efficacy of these approaches to more established techniques; however, early perioperative outcomes appear promising.