Combined Robot-Assisted Radical Cystectomy and Robot-Assisted Nephroureterectomy for Synchronous High-Risk Upper...

Background/Objectives: Simultaneous robotic-assisted radical cystectomy (RARC) and nephroureterectomy (RARNU) offers a minimally invasive alternative to open approach for patients with synchronous bladder and upper urinary tract cancers, as well as in selected benign conditions. This study presents our single-center experience and also includes a review of the relevant literature. Methods: All patients undergoing combined RARC and RARNU between 2016 and 2023 were retrospectively identified. Clinical and demographic data-including preoperative pathology, operative and re-docking times, estimated blood loss, complications (Clavien-Dindo system), surgical margins, recurrence, morbidity, and follow-up-were collected. A rapid review of the literature was also conducted. Results: From 2016 to 2023, 10 patients (mean age 67.4 years, range 56-77) underwent combined RARC and RARNU for upper/lower tract urothelial malignancy. Mean re-docking time was 68.2 min (range 51-100), mean operative time 524.5 min (range 380-690), and mean blood loss 427 cc (range 75-1170). A Pfannenstiel incision was used for en bloc specimen extraction, with no complications or incisional hernias. One case was converted to open surgery, and two required extracorporeal diversion. Postoperatively, five Grade 2 complications were reported, along with one Grade 3, and one Grade 5. All surgical margins were negative. Mean hospital stay was 11.5 days (range 5-29). At a mean follow-up of 21.7 months, one patient had become dialysis-dependent and one had experienced recurrence requiring further surgery. The review of the literature included 74 patients with comparable outcomes. Conclusions: Combined RARC and RARNU is a feasible, minimally invasive option for selected patients. Although technically demanding, it offers acceptable safety and should be performed in high-volume, specialized centers.