V11-10 ROBOTIC RETROPERITONEAL NEPHROURETECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

Abstract

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-10 ROBOTIC RETROPERITONEAL NEPHROURETECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Zachary McDowell, and James Porter Zachary McDowellZachary McDowell More articles by this author , and James PorterJames Porter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephroureterectomy is the standard of care for high grade upper tract urothelial carcinoma (UTUC) or low grade UTUC when nephron-sparing surgery is not possible, and a retroperitoneal approach can be advantageous in the setting of previous abdominal surgeries. The patient in this case is a 67 year old female that was found to have high grade urothelial carcinoma of the left renal pelvis. She underwent 3 cycles of gemcitabine and cisplatin chemotherapy, and subsequent nephroureterectomy. A retroperitoneal approach was chosen for this patient because she had a history of multiple abdominal surgeries including exploratory laparotomy. This video will demonstrate the retroperitoneal approach for robotic nephroureterectomy as definitive surgical management of this patient's high grade UTUC. METHODS: The surgery was performed using the daVinci Xi robot. The patient was placed in full flank position and 4 robotic ports were placed in a line midway between the iliac crest and the 12th rib. A 12mm high-flow insufflator assistant port was placed near the anterior superior iliac spine. The retroperitoneal space was developed using balloon dilation. The initial step was mobilization of the ureter. Once the ureteral dissection was carried distally to the point of decreased range of motion for the robotic arms, the arms were undocked, the boom rotated 180 degrees, and the direction of dissection was into the pelvis. An additional 5mm assistant port was placed cephalad to the robotic ports near the 11th rib. After completion of the ureteral and bladder cuff dissection the robot was redocked and returned to the initial arm configuration. We then proceed to adrenal sparing radical nephrectomy with retroperitoneal lymph node dissection. RESULTS: We have experience with 3 robotic retroperitoneal nephroureterectomies. All patients had high grade transitional cell carcinoma of the kidney as the indication for surgery, and all had history of significant abdominal surgery. The mean age was 70 years, mean operative time was 251 mins, mean estimated blood loss was 42 cc, mean lymph nodes removed was 13, and mean length of stay of 2 days. There were no complications, readmissions, and recurrences. CONCLUSIONS: The retroperitoneal approach is a safe and effective technique for robotic assisted nephroureterectomy. This approach allows complete access to the kidney, ureter and bladder cuff and avoids adhesions in patients with prior abdominal surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e860-e861 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary McDowell More articles by this author James Porter More articles by this author Expand All Advertisement Loading ...