Precision in kidney-sparing surgery: Robot-assisted ureterectomy with novel Black Eye™ Ink

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Upper tract urothelial carcinoma (UTUC) is a rare malignancy.
• Radical nephroureterectomy (RNU) is the standard treatment, but it results in loss of renal function.
• Kidney-sparing surgery (KSS) options are being explored for localized UTUC.

Purpose of the Study:

• To evaluate the feasibility, oncological efficacy, and safety of robotic segmental ureterectomy (SU) for localized UTUC.
• To assess the role of Black Eye™ Endoscopic Marker Ink in delineating tumor margins during SU.
• To compare SU with RNU in terms of surgical outcomes and oncological control.

Main Methods:

• Prospective non-randomized trial (January 2018 - December 2022) of patients with localized UTUC.
• Robotic segmental ureterectomy (SU) performed with Black Eye™ Endoscopic Marker Ink for tumor delineation.
• Propensity score matching used for comparison with standard radical nephroureterectomy (RNU).

Main Results:

• Thirty patients underwent SU with one local recurrence at a median follow-up of 35 months.
• SU demonstrated significantly shorter operative times compared to RNU (p < 0.001).
• No significant differences in complication scores or oncological outcomes between SU and RNU groups.

Conclusions:

• Robotic segmental ureterectomy (SU) using Black Eye™ Endoscopic Marker Ink is a viable KSS technique for select UTUC patients.
• This approach is safe, effective, and preserves renal function.
• It offers a promising alternative to RNU, potentially reducing positive surgical margins.