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

P Sparwasser1, S Epple2, A Thomas2

  • 1Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany. peter.sparwasser@unimedizin-mainz.de.

World Journal of Urology
|January 17, 2022
PubMed
Summary

This study introduces robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff, a novel technique for upper tract urothelial cancer (UTUC). The RRNU procedure is safe, feasible, and reproducible, offering outcomes comparable to existing methods.

Keywords:
Bladder cuffDaVinciNephroureterectomyRetroperitonealRobotic surgeryTrocar placement

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Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • Upper tract urothelial cancer (UTUC) treatment typically involves open or minimally invasive nephroureterectomy (NU).
  • Existing robot-assisted NU techniques often require abdominal cavity entry.
  • A novel retroperitoneal approach for robot-assisted NU has not been previously reported.

Purpose of the Study:

  • To describe a novel technique for robot-assisted nephroureterectomy (NU) with bladder cuff using a completely retroperitoneal approach.
  • To evaluate the safety and feasibility of this entirely retroperitoneal robot-assisted NU (RRNU).

Main Methods:

  • A prospective analysis of five patients with UTUC treated between February and June 2021.
  • The procedure involved a unique retroperitoneal port placement and a two-step robotic docking without relocation.
  • Patient characteristics, perioperative outcomes, and short-term follow-up were analyzed.

Main Results:

  • Five patients (median age 73 years) underwent RRNU for UTUC (mean tumor size 3.02 cm).
  • No positive surgical margins or intraoperative adverse events (≥ EAUiaiC 2) were observed.
  • Median estimated blood loss was 150 ml, with no postoperative complications (≥ Clavien-Dindo 3a) and a median hospital stay of 5.4 days.

Conclusions:

  • The study demonstrates the first entirely robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff.
  • This novel surgical technique is safe, feasible, and easily reproducible.
  • Surgical outcomes of RRNU are comparable to established NU techniques for UTUC.