Robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy with bladder cuff excision for upper tract urothelial carcinomas: preliminary experience

Abstract

ObjectiveTo present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy (RLESS-RNU) with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma (UTUC). MethodsFifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed by our medical institution (The Second Affiliated Hospital of Nanjing Medical University), from our prospectively maintained institutional database. The da Vinci® Xi system (Intuitive Surgical, Sunnyvale, CA, USA) was utilized for surgical procedures on all patients. An in-depth analysis was conducted on their baseline demographic characteristics, pathological factors, and perioperative details. The complete surgical process and details are elaborated. ResultsThe median age of 15 patients was 67 years. The final pathology demonstrated 46.67% (7/15) patients with the pT1 stage or lower and 46.67% (7/15) with the pT3 stage; one patient could not undergo pathological staging because of preoperative chemotherapy. The perioperative outcomes revealed that the mean operative time was 185 (standard deviation [SD] 23.05) min. The time for the trocar placement including primary docking was 15 (SD 0.85) min and the time of second docking was 8 (SD 0.52) min. The median of estimated blood loss was 55 mL. The mean drainage tube duration and postoperative stay were 7.50 days and 11.00 days, respectively. After a mean follow-up period of 24.20 months, the relapse-free survival rate was 86.67%. Two patients experienced disease progression; one patient exhibited multifocal evidence of non-muscle invasive bladder cancer, and another patient developed systemic recurrence. ConclusionThis study demonstrates the modified technique for RLESS-RNU is safe and satisfactory for UTUC.