Optimized Patient Positioning and Port Placement for Robot-Assisted Laparoscopic Radical Nephroureterectomy in Distal
Akihito Hashizume1, Takashi Kawahara1, Masanobu Yamazaki1
1Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
Introduction:
Robot-assisted laparoscopic radical nephroureterectomy (RANU) is increasingly utilized in the management of upper tract urothelial carcinoma. However, detailed techniques for addressing distal ureteral carcinoma, particularly those involving partial cystectomy and pelvic lymph node dissection (PLND), remain limited, primarily due to challenges related to surgical positioning and port placement.
Case Presentation:
We report the case of a 69-year-old woman diagnosed with cT2N1M0 left distal ureteral carcinoma, extending into the bladder. She received neoadjuvant chemotherapy followed by RANU. To optimize surgical positioning and port placement, we employed a modified lateral decubitus position during the nephrectomy phase and subsequently rotated the operating table for optimal pelvic access. This enabled effective partial cystectomy and PLND with addition of only one extra robotic port. The total operative time was 4 h and 21 min, with a robotic console time of 3 h and 17 min. Estimated blood loss was minimal at 13 mL. There were no complications or transfusions required.
Conclusion:
Our modified RANU technique, utilizing optimized patient surgical positioning and port placement, enabled safe and effective performance of facilitated partial cystectomy and PLND in a patient with invasive distal ureteral carcinoma. This approach offers a valuable option for challenging cases and warrants further investigation.
