Mediathek

Abstract

I.Tsaur¹, S. Epple¹, R. Dotzauer¹, A. Thomas¹, M.P. Brandt¹, H. Borgmann¹, R. Mager¹, T. Höfner¹, A. Haferkamp¹, P. Sparwasser1
¹Unimedizin Johannes Gutenberg Mainz, Urologie, Mainz, Deutschland

Introduction: While 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.

Methods: Patients with history of UTUC were treated by NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot (DaVinciXi®). Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed, as well a surgical video was exemplarily recorded for one patient.

Results: We analyzed 5 patients [female/male: 3/2; age: 73yr; BMI: 27.2kg/m2; Charlson Comorbidity Index 5]. While mean trocar placement took 28min, console time was 124,4min. All 5 patients had UTUC with mean tumor size of 3.02cm [ureter: 2; kidney: 3]. No positive surgical margins were noted [1 low-grad; 4 high-grade]. Lymphadenectomy revealed no positive nodes in 3 patients. No intraoperative adverse events exceeding EAUiaiC≥2 [median EBL: 150ml] and no postoperative complications exceeding Clavien Dindo≥3a were observed. Sufficient cystography was performed in all cases and mean hospital stay was 5.4d without any 30d-readmission.

Conclusion: This is the first description of an entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This safely performed surgical technique is easily reproducible and offers great potential for selected patients even if further investigation with comparison to other well-established techniques is necessary.