Robot-assisted Nephroureterectomy Research Articles

Robot-Assisted Distal Ureterectomy Versus Robot-Assisted Nephroureterectomy in High-Risk Distal Ureteral Urothelial Carcinoma: A Multi-institutional Analysis (ROBUUST 2.0 Collaborative Group)

Robot-Assisted Distal Ureterectomy Versus Robot-Assisted Nephroureterectomy in High-Risk Distal Ureteral Urothelial Carcinoma: A Multi-institutional Analysis (ROBUUST 2.0 Collaborative Group)

Modified robot-assisted nephroureterectomy with ureteral catheterization for radical resection of the distal ureter: Procedures and short-term outcomes

ObjectivesTo describe a bladder cuff excision method modified with ureteral catheterization to better visualize the ureteral orifice during robot-assisted nephroureterectomy (RANU). MethodsWe retrospectively analyzed 66 patients with upper urinary tract urothelial carcinoma of the renal pelvis and/or upper-mid ureter treated between January 2020 and January 2023. Among them, 32 patients (group A) underwent RANU supported by ureteral catheterization, and the remaining patients (group B) received routine transperitoneal RANU. Postoperative cystoscopy was performed routinely to compare the rates of residual ureteral orifice between the two groups. ResultsSurgeries were completed uneventfully in all 66 patients, without blood transfusion or conversion to open procedures. The operative time, estimated blood loss, and postoperative length of hospital stay were similar between both groups. However, the mean time required for BCE in group A was shorter than that in group B (9.5 min vs. 16.0 min, p = 0.006). Cystoscopy at postoperative three months showed no ipsilateral ureteral orifice in group A, but residual ureteral orifice was found in 23.5% of patients in group B. During a short follow-up period of 16 months, no patients in group A experienced bladder tumor recurrence. However, two patients (5.9%) in group B developed bladder tumor recurrence, with one experiencing local tumor recurrence at the level of the ureteral stump. ConclusionsOur novel technique enables complete ureteral retrieval, accurate and rapid bladder cuff excision, which makes the procedure less invasive and safely reproducible during robot-assisted nephroureterectomy.

Assessment of the Degree of Minimal Invasiveness in Completely Retroperitoneal Robot-Assisted Nephroureterectomy

Assessment of the Degree of Minimal Invasiveness in Completely Retroperitoneal Robot-Assisted Nephroureterectomy

A case of seronegative microscopic polyangiitis following the diagnosis of renal pelvic carcinoma.

The incidence rate of malignancy in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is higher than that in the general population. Malignancy has been indicated to be a risk factor or inducer of AAV. Herein, we report the case of a healthy 84-year-old man with seronegative microscopic polyangiitis (MPA) after thediagnosis of renal pelvic carcinoma. Four weeks before admission, his estimated glomerular filtration rate (eGFR) was 85ml/min/1.73m2, and nohematuria or proteinuria was detected. Renal biopsy on admission revealed invasive urothelial carcinoma of the right renal pelvis. On day 15, his eGFR decreased to 30ml/min/1.73m2 without any incitement. The renal specimen extracted via right robot-assisted nephroureterectomy indicated the presence of ANCA-associated glomerulonephritis. On day 37, urinary protein/urinary creatinine level of 6.48g/gCre, serum albumin level of 2.1mg/dL, and eGFR of 20ml/min/1.73m2 indicated the presence of nephrotic syndrome. His blood sputum was analyzed via chest computed tomography, which revealed alveolar hemorrhage. Although his myeloperoxidase-ANCA was negative, he was diagnosed with MPA based on the 2022 American College of Rheumatology/European League Against Rheumatism classification criteria. This is the first case report of MPA orAAV complicated with renal pelvic carcinoma. The clinical indicators demonstrated that renal pelvic carcinoma preceded the onset of MPA. The spatial proximity of both diseases indicated that renal pelvic carcinoma had some influence on MPA development via the mechanism of inflammatory cytokines or neutrophil extracellular traps. Our report may be useful in elucidating the mechanism of MPA development.

Retroperitoneal Single-Port Robot-Assisted Nephroureterectomy with Bladder Cuff Excision: Initial Experience and Description of the Technique.

With the introduction of the single-port (SP) robot, surgery that was difficult to attempt is becoming possible. Nephroureterectomy (NUx) for upper tract urothelial carcinoma also seems to be able to attempt a retroperitoneal (RP) approach. to investigate the feasibility of SP robotic RP NUx with bladder cuff excision. we sequentially analyzed 20 patients who underwent SP robot NUx from January 2021 to December 2022. all patients were diagnosed with upper tract urothelial carcinoma (UTUC) and were operated upon by a single expert using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA, USA) with retroperitoneal approach. A total of 20 patients underwent SP robotic NUx with bladder cuff excision. The mean age of patients was 69.45 ± 8.68 years, and the mean body mass index (BMI) was 25.37 ± 3.00 kg/m2. The mean tumor size was 2.42 ± 1.03 cm on a CT scan, with right-sided tumors in eight patients (40%) and left-sided tumors in 12 patients (60%). The median console time was 106 min and 40 s, and the expected blood loss was 122.50 ± 75.18 mL. Final pathology showed that all of the patients were diagnosed as having urothelial carcinoma; one patient was classified as Ta (5.00%), three patients were classified as T1 (15.00%), seven patients were classified as T2 (35.00%), eight patients were classified as T3 (40.00%), and one patient was classified as T4 (5.00%). None of these 20 patients showed any complications based on the Clavien-Dindo scale. SP robotic NUx using a retroperitoneal approach provides feasible perioperative and postoperative outcomes for UTUC.

ASO Visual Abstract: FirstComparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single-Center Study.

ASO Visual Abstract: FirstComparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single-Center Study.

First Comparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single Center Study.

After recent presentation of the first complete robot-assisted retroperitoneal nephroureterectomy with bladder cuff (RRNU) for patients with upper tract urothelial cancer (UTUC), we aimed to compare this new surgical technique with robot-assisted transperitoneal nephroureterectomy (TRNU) representing the current standard of care. Robot-assisted nephroureterectomies (NUs) were retrospectively analyzed and compared based on two groups: transperitoneal versus retroperitoneal approach. Baseline data were collected for patient demographics, tumor characteristics, intra- (EAUiaiC) and postoperative (Clavien-Dindo) complications, and perioperative variables. Tumor characteristics included grade of malignancy, clinical stage, and surgical margin status.Short-term follow-up data including 30-day readmission rates were collected. Statistical analyses were performed assuming a significant p-valueof < 0.05. The analysis includes perioperative patient data after proven UTUC of 24 TRNU versus 12 RRNU (mean age: 70 versus 71 years; BMI: 25.9 versus 26.1 kg/m2; CCI score ≥ 4: 83% versus 75%;ASA score ≥ 3: 37% vs 33%).Intraoperative (16.4% vs 0%, p = 0.35) and postoperative (25% vs 12.5%, p = 0.64) complications demonstrated no significant discrepancy. Notably, RRNU demonstrated significantly shorter surgery time (p < 0.05) and length of stay (p < 0.05). There was no significant difference in histopathological tumor characteristics, whereas significantly more lymph nodes were removed through RRNU (11.0±3.3vs. 6.4±5.1, p < 0.05). Finally, no statistical difference was shown in short-term follow-up. We report the first head-to-head comparison between RRNU and TRNU. RRNU proves to be a safe and feasible approach which appears to be non-inferior to TRNU. RRNU expands the spectrum of minimally invasive treatment options, particularly for patients with major previous abdominal surgery.

PD46-12 COMPARING THE PERIOPERATIVE OUTCOMES OF OPEN RADICAL NEPHROURETERECTOMY AND ROBOT ASSISTED NEPHROURETERECTOMY USING PROPENSITY SCORE MATCH ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD46-12 COMPARING THE PERIOPERATIVE OUTCOMES OF OPEN RADICAL NEPHROURETERECTOMY AND ROBOT ASSISTED NEPHROURETERECTOMY USING PROPENSITY SCORE MATCH ANALYSIS Sheshang Kamath, Abhinav Veerwal, Akash Shah, and Thyavihally Yuvaraja Sheshang KamathSheshang Kamath More articles by this author , Abhinav VeerwalAbhinav Veerwal More articles by this author , Akash ShahAkash Shah More articles by this author , and Thyavihally YuvarajaThyavihally Yuvaraja More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although Open radical nephroureterectomy (O-RNU) with bladder cuff excision (BCE) remains the gold standard for management of management of upper tract urothelial carcinoma, the trend has been changing globally towards minimal invasive surgery after the meta- analysis published by the European guidelines. We intend to specifically evaluate the intraoperative and post-operative aspects of Robot assisted nephroureterectomy (RANU) with BCE with respect to O-RNU with BCE for wider application RANU if feasible. METHODS: This study is a retrospectives study, the data of which was obtained from a prospectively maintained cancer registry of the oncology department in our tertiary care institute. The data was obtained between January 2011 and July 2022 from a single center operated by a single surgeon to avoid surgeon and institution bias. Univariate analysis was performed for baseline parameters, pathologic and perioperative outcomes among the two groups using Chi square test for categorical variables and student t-test was used for continuous variables. Multivariate logistic regression analysis was then performed. Propensity score match analysis (PSM) 1:1 was used to independently evaluate the lymph node yield, postoperative complications of Clavien Dindo grade 3 and above and time to discharge from the hospital after matching for the patient and tumor characteristics. The value of p considered significant was<0.05. RESULTS: Among 352 patients, 288 O-RNU and 64 RANU were performed. Median age of patient was 69 (IQR 54-71) in O-RNU and 70 (IQR 56-73) in RANU. Most common tumor stage for both arms was T2 (46.2 % in O-RNU vs 51.5% in RANU) Total operative time among both groups was higher in open surgery (180±17 minutes in O-RNU vs 153±10 minutes in RANU. Perioperative factors significantly improved among RANU group was lymph node yield, Clavien Dindo complications 3 or more and time to discharge in multivariate logistic regression. PSM 1:1 done for 64 nephroureterectomies in each group matched for baseline patient and tumor variables found only time to discharge and readmission rates to be significantly lesser in the RANU group. CONCLUSIONS: Although cost of surgery increases, propensity score analysis shows readmission rates and hospital stay significantly lesser in the robotic group, thereby significantly impacting the post-operative wellbeing of the patients. The retrospective nature of the study remains a drawback of this study, however we feel this study should urge more intuitions across the globe to start implementing RANU to give a prospective and global perspective. Source of Funding: We have no source of funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1174 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sheshang Kamath More articles by this author Abhinav Veerwal More articles by this author Akash Shah More articles by this author Thyavihally Yuvaraja More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison between robot-assisted versus open nephroureterectomy for upper tract urothelial carcinoma: outcomes from a pooled analysis.

The present study aimed to compare the efficacy and safety between robot-assisted nephroureterectomy (RANU) and open nephroureterectomy (ONU) for the treatment of upper tract urothelial carcinoma (UTUC). We systematically searched four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) to locate pertinent studies published in English up to January 2023. The primary outcomes evaluated included perioperative results, complications, and oncologic outcomes. Statistical analyses and calculations were performed using Review Manager 5.4. The study was registered with PROSPERO (ID: CRD42022383035). In total, eight comparative trials, including 37,984 patients were enrolled. Compared to ONU, RANU was associated with a significantly shorter length of stay (weighted mean difference [WMD] - 1.63days, 95% confidence interval [CI] - 2.90, - 0.35; p = 0.01), less blood loss (WMD - 107.04mL, 95% CI - 204.97, - 9.11; p = 0.03), less major complication(OR 0.78, 95% CI 0.70, 0.88; p < 0.0001), and lower positive surgical margin (PSM) (OR 0.33, 95% CI 0.12, 0.92; p = 0.03). However, no statistically significant differences were observed between the two groups in operative time, transfusion rates, rate of lymph node dissection, lymph node yield, overall complications, overall survival, cancer-specific survival, recurrence-free survival, and progression-free survival. RANU has superior advantages compared to ONU in terms of length of hospital stay, blood loss, postoperative complications, and PSM, while providing comparable oncologic outcomes in patients with UTUC.

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma—feasibility and complications: a single center experience

Background Robot-assisted nephroureterectomy (RANU) is the primary treatment for upper tract urothelial carcinoma (UTUC) at our hospital for patients with clinical stage less than T2, and for patients with invasive tumours, but unfit for major surgery. Objective To assess peri-operative conditions and outcomes of RANU at our unit, and to evaluate the safety of the procedure. Methods The medical records of all 166 patients undergoing RANU for suspected UTUC and followed for more than three months in a large university hospital in Sweden were reviewed retrospectively. After the exclusion of twenty patients because of previous cystectomy, simultaneous surgical procedure, or other tumour types than UTUC in the pathological report, 146 patients remained for the analyses. The primary endpoint was complication rate according to Clavien-Dindo at 90 days. Secondary endpoints were perioperative bleeding, violation of oncological surgical principles, hospital stay, and re-admission within 90 days. Results The median age was 75 [(Inter Quartile Range) IQR 70–80] years and 57% of the patients had an ASA score above 2. According to Clavien-Dindo, one patient had a grade 3 complication, and no patient had a grade 4–5 complication. The median blood loss was 50 (IQR 20–100) ml and the median hospital stay was 6 (IQR 5–7) days. Twelve patients were re-admitted to the hospital within 90 days (eight with urinary tract infection/haematuria, one with hematoma, and three with other diseases). Conclusion Robot-assisted nephroureterectomy is a safe procedure for patients with upper tract urothelial carcinoma, with a low risk of major surgical complications.

V09-10 NEWLY ESTABLISHED APPROACH OF AN ENTIRELY RETROPERITONEAL ROBOTIC NEPHROURETERECTOMY

You have accessJournal of UrologyCME1 May 2022V09-10 NEWLY ESTABLISHED APPROACH OF AN ENTIRELY RETROPERITONEAL ROBOTIC NEPHROURETERECTOMY Peter Sparwasser, Stefan Epple, Anita Thomas, Robert Dotzauer, Katharina Böhm, Maximilian Peter Brandt, Kamal Gheith, Rene Mager, Martin Kurosch, Hendrik Borgmann, Thomas Höfner, Axel Haferkamp, and Igor Tsaur Peter SparwasserPeter Sparwasser More articles by this author , Stefan EppleStefan Epple More articles by this author , Anita ThomasAnita Thomas More articles by this author , Robert DotzauerRobert Dotzauer More articles by this author , Katharina BöhmKatharina Böhm More articles by this author , Maximilian Peter BrandtMaximilian Peter Brandt More articles by this author , Kamal GheithKamal Gheith More articles by this author , Rene MagerRene Mager More articles by this author , Martin KuroschMartin Kurosch More articles by this author , Hendrik BorgmannHendrik Borgmann More articles by this author , Thomas HöfnerThomas Höfner More articles by this author , Axel HaferkampAxel Haferkamp More articles by this author , and Igor TsaurIgor Tsaur More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While several surgical techniques have been established for both open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) including excision of the bladder cuff has never been reported using only retroperitoneum. We developed a novel port placement and step-by-step technique allowing to perform robot-assisted NU by an unique retroperitoneal approach without relocation of the surgical robot. METHODS: Between February and June 2021 patients with history of UTUC and indication for surgery were treated by robot-assisted NU completely restricted to the retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot (DaVinci® Xi). Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. RESULTS: This analysis included 5 patients [mean age: 67.4yr; BMI: 28.2kg/m2; Charlson comorbidity index 5.2]. All 5 patients had UTUC with a mean tumor size of 3.02cm (range 0.9-6.0). UTUC was thereby localized to distal ureter in 2 and to kidney in 3 cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in 3 patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥2 were observed, while EBL was 200ml (range 100-450). No patient experienced postoperative complications exceeding Clavien Dindo classification ≥3a. Median hospital stay was 5.4d without any 30d-readmission. CONCLUSIONS: We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques. Prospective research is warranted in order to robustly evaluate its supposed benefits over transperitoneal approaches. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e807 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Sparwasser More articles by this author Stefan Epple More articles by this author Anita Thomas More articles by this author Robert Dotzauer More articles by this author Katharina Böhm More articles by this author Maximilian Peter Brandt More articles by this author Kamal Gheith More articles by this author Rene Mager More articles by this author Martin Kurosch More articles by this author Hendrik Borgmann More articles by this author Thomas Höfner More articles by this author Axel Haferkamp More articles by this author Igor Tsaur More articles by this author Expand All Advertisement PDF DownloadLoading ...

A0294 - Laparoscopic vs. Robot-assisted nephroureterectomy: Propensity score matched comparison of surgical and early oncologic outcomes

A0294 - Laparoscopic vs. Robot-assisted nephroureterectomy: Propensity score matched comparison of surgical and early oncologic outcomes

First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique

IntroductionWhile various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach.MethodsBetween February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed.ResultsThe analysis included five patients [median age: 73 years; BMI: 27.2 kg/m2; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission.ConclusionWe demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques.

Initial Experience of Robot-Assisted Laparoscopic Nephroureterectomy in Japan: A Useful Technique Using a Vessel Sealing Device for Securing a Good Surgical Field and Efficient Sealing.

Although robot-assisted nephroureterectomy (RANU) has been increasingly used worldwide, the history of RANU remains short, and the optimal surgical method for performing RANU has yet to be established. Here we introduce the ideal approach for RANU using the Vessel Sealer Extend (VSE). RANU was performed by using a da Vinci Xi surgical system with fenestrated bipolar forceps (by the left arm), and monopolar scissors or needle drivers (by the right arm), and the VSE (by the third arm). First, nephrectomy and lymphadenectomy were performed at the kidney direction stage, followed by the removal of the distal ureter and suturing of the bladder at the bladder direction stage. The key point of our technique is that the console surgeon can continue to obtain the optimal surgical field by traction using the third arm, and thus cut the tissue by smoothly switching between the right hand and the third arm without the need to exchange instruments, especially in the kidney direction stage. In this study we performed RANU in nine patients and lymphadenectomy in seven patients. The median console time was 195 (range: 165-265) min, the median blood loss was 55 (range: 5-179) ml. In eight cases of RANU using the VSE, no lymphatic leakage was observed and all procedures could be performed safely. The use of VSE provides sufficient coagulation and optimal surgical field development, thus allowing console surgeons to perform RANU more safely.

Robot-assisted nephroureterectomy requiring no robot redocking or patient repositioning: experience from a single center with 62 cases

Objective: To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning. Methods: Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient's side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A "W"-shape, three robotic-arm configurations was used for port placement. Results: The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57). Conclusion: Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.

Surgical benchmarks, mid-term\xa0oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

BackgroundSimultaneous urothelial cancer manifestation in the lower and upper urinary tract affects approximately 2% of patients. Data on the surgical benchmarks and mid-term oncological outcomes of enbloc robot-assisted radical cystectomy and nephro-ureterectomy are scarce.MethodsAfter written informed consent was obtained, we prospectively enrolled consecutive patients undergoing enbloc radical cystectomy and nephro-ureterectomy with robotic assistance from the DaVinci Si-HD® system in a prospective institutional database and collected surgical benchmarks and oncological outcomes. Furthermore, as one console surgeon conducted all the procedures, whereas the team providing bedside assistance was composed ad hoc, we assessed the impact of this approach on the operative duration.ResultsNineteen patients (9 women), with a mean age of 73 (SD: 7.5) years, underwent simultaneous enbloc robot-assisted radical cystectomy and nephro-ureterectomy. There were no cases of conversion to open surgery. In the postoperative period, we registered 2 Clavien-Dindo class 2 complications (transfusions) and 1 Clavien-Dindo class 3b complication (port hernia). After a median follow-up of 23 months, there were 3 cases of mortality and 1 case of metachronous urothelial cancer (contralateral kidney).The total operative duration did not decrease with increasing experience (r = 0.174, p = 0.534). In contrast, there was a significant, inverse, strong correlation between the console time relative to the total operative duration and the number of conducted procedures after adjusting for the degree of adhesions and the type of urinary diversion(r = -0.593, p = 0.02).ConclusionsThese data suggest that en bloc simultaneous robot-assisted radical cystectomy and nephro-ureterectomy can be safely conducted with satisfactory mid-term oncological outcomes. With increasing experience, improved performance was detectable for the console surgeon but not in terms of the total operative duration. Simulation training of all team members for highly complex procedures might be a suitable approach for improving team performance.Trial registration: Not applicable.Dm4iGs5nWD8FkGrYCfJL2MVideo

V025 - Robot-assisted nephroureterectomy with bladder cuff excision. A demonstration of the single-stage technique

V025 - Robot-assisted nephroureterectomy with bladder cuff excision. A demonstration of the single-stage technique

Robot-assisted nephroureterectomy: Single Stage Technique including Bladder Cuff

Robot-assisted nephroureterectomy: Single Stage Technique including Bladder Cuff

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: results from three high-volume robotic surgery institutions.

Robot-Assisted NephroUreterectomy (RANU) represents a minimally invasive alternative to open NephroUreterectomy (NU) for management of Upper Tract Urothelial Carcinoma (UTUC) but its oncologic safety is still controversial. The objective of this study was to investigate the peri-operative, pathologic and oncologic outcomes of RANU for UTUC. From 2008 to 2017, 78 patients diagnosed with UTUC and elected for RANU at 3 high-volume robotic surgery centres were retrospectively assessed. Surgery was performed using da Vinci Si® and Xi® systems. RANU was done adhering to oncological principles as in open surgery. The outcomes of the study were: (1) peri-operative morbidity, namely intra- and post-operative complications, blood loss, length of hospital stay and operative time; (2) oncologic outcomes, namely overall survival (OS) and recurrence-free survival (RFS). Peri-operative overall complication rate was 24.4% and high-grade complication rate was 2.6%. Median blood loss, length of hospital stay and operative time were 124ml, 4 days and 167min. Lymphadenectomy was performed in 31 (41%) patients. Lymph-node involvement was present in 9 (29%) patients. At median follow-up of 15months, 2- and 4-year OS were 79% and 66%, respectively, and RFS was 63% and 53%. Peritoneal dissemination was recorded in 1 (1.3%) patient with pT4N2R1 UTUC. Our study is limited by the relatively small cohort of patients and its retrospective character. RANU as minimally invasive treatment for patients with UTUC is safe and feasible. Post-operative morbidity is low and major complications are rare. Oncologic outcomes are acceptable and no evidence of increased risk of peritoneal dissemination is recorded. Long-term data are needed. RANU should be regarded as an alternative to open surgery for UTUC that can offer good peri-operative and oncologic results.

PE63 - Robot-assisted nephro-ureterectomy for upper tract urothelial carcinoma: Results from two high-volume robotic surgery institutions

PE63 - Robot-assisted nephro-ureterectomy for upper tract urothelial carcinoma: Results from two high-volume robotic surgery institutions