Pure Retroperitoneal Robot-Assisted Radical Nephroureterectomy (RANU): Initial Experience Using the Hinotori Surgical...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Upper tract urothelial carcinoma (UTUC) frequently necessitates nephroureterectomy.
• The retroperitoneal robotic approach, especially with the hinotori system, presents potential benefits for smaller patients.

Purpose of the Study:

• To evaluate the safety and feasibility of pure retroperitoneal robot-assisted nephroureterectomy (RANU) using the hinotori system in patients with UTUC.
• To assess outcomes such as operative time, re-docking, and complications in this patient cohort.

Main Methods:

• A cohort of five UTUC patients (≤162 cm) underwent pure retroperitoneal RANU with the hinotori system.
• Standardized trocar placement was employed without port relocation.
• Key outcomes monitored included operative duration, re-docking time, and any intraoperative or postoperative complications.

Main Results:

• All five procedures were successfully completed without peritoneal entry, conversion to open surgery, or major complications.
• The mean operative time was 257 minutes, with an average re-docking time of 18 minutes.
• All patients achieved negative surgical margins, and no 30-day readmissions were recorded.

Conclusions:

• Pure retroperitoneal RANU with the hinotori system is a safe and feasible option for UTUC treatment, particularly in smaller-framed individuals.
• This approach minimizes procedural interference and may be a valuable alternative to transperitoneal nephroureterectomy.
• Further research is warranted to validate oncological outcomes and optimize surgical techniques.