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Keywords:

  • urothelial carcinoma;
  • nephroureterectomy;
  • robotic surgery

Objective

  • 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.

Results

  • 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.

Conclusions

  • 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.