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

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.