Perioperative outcomes of robot‐assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi‐institutional series. (23rd July 2013)

• Record Type: Journal Article
• Authors: Pugh, Joseph; Parekattil, Sijo; Willis, Daniel; Stifelman, Michael; Hemal, Ashok; Su, Li‐Ming
• Is Part Of: BJU international. Volume 112:Number 4(2013:Aug.)
• Page Start: E295
• Page End: E300
• Publication Date: 2013-07-23
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12163
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12163-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12163-list-0001" list-type="bullet"> <list-item> <p>To review a multi‐institutional series of robot‐assisted nephroureterectomy (RANU) for management of upper urinary tract urothelial carcinoma (UUTUC) with respect to technique and perioperative outcomes.</p> </list-item> </list> </p> </sec> <sec id="bju12163-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12163-list-0002" list-type="bullet"> <list-item> <p>Between May 2007 and July 2011, 43 RANU were performed at three institutions for UUTUC with review of perioperative outcomes.</p> </list-item> <list-item> <p>A three‐ or four‐armed robotic technique was used in all cases based on surgeon preference and the entirety of all procedures was performed using the robot‐assisted technique.</p> </list-item> <list-item> <p>Single and two robot‐docking techniques are described.</p> </list-item> </list> </p> </sec> <sec id="bju12163-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12163-list-0003" list-type="bullet"> <list-item> <p>The mean (range) operating time was 247 (128–390) min, blood loss was 131 (10–500) mL and the median (range) length of stay was 3 (2–87) days.</p> </list-item> <list-item> <p>Pathology was pTa in nine patients, pT1 in 14 patients, pT2 in three patients, pT3 in 15 patients and pT4 in two patients.</p> </list-item> <list-item> <p>Lymph node dissection was performed in 22 patients (51%) with a mean (range) lymph node count of 11 (4–23).</p> </list-item> <list-item> <p>There were six postoperative complications: bleeding requiring a blood transfusion (grade II), splenic bleeding (grade IV), two cases of pneumonia (grade II) and two cases of rhabdomyolysis (grades II and IV).</p> </list-item> <list-item> <p>Nine recurrences (six bladder, two within the retroperitoneum and one in the contralateral collecting system) have been found to date on routine surveillance with a mean follow‐up of 9 months.</p> </list-item> </list> </p> </sec> <sec id="bju12163-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12163-list-0004" list-type="bullet"> <list-item> <p>RANU is a feasible alternative to laparoscopic and open techniques.</p> </list-item> <list-item> <p>Particular steps of the operation including sutured closure of the cystotomy and regional lymphadenectomy are facilitated with the use of robot‐assisted surgery.</p> </list-item> <list-item> <p>Long‐term outcomes are necessary to assess the relative efficacy of these approaches to more established techniques; however, early perioperative outcomes appear promising.</p> </list-item> </list> </p> </sec> </abstract>