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Minerva Urology and Nephrology 2022 April;74(2):233-41

DOI: 10.23736/S2724-6051.21.04247-8


language: English

Single-stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes

Alessandro VECCIA 1, Umberto CARBONARA 1, Ithaar DERWEESH 2, Reza MEHRAZIN 3, James PORTER 4, Firas ABDOLLAH 5, Elio MAZZONE 6, 7, Chandru P. SUNDARAM 8, Mark GONZALGO 9, Riccardo MASTROIANNI 10, Alireza GHOREIFI 11, Giovanni E. CACCIAMANI 11, Devin PATEL 2, Jamil MARCUS 5, Alyssa DANNO 5, James STEWARD 8, Amit SATISH BHATTU 9, Aeen ASGHAR 12, Adam C. REESE 12, Zhenjie WU 13, Robert G. UZZO 14, Andrea MINERVINI 15, Koon H. RHA 16, Matteo FERRO 17, Vitaly MARGULIS 18, Lance J. HAMPTON 1, Giuseppe SIMONE 10, Daniel D. EUN 12, Hooman DJALADAT 11, Alexandre MOTTRIE 6, 7, Riccardo AUTORINO 1

1 Division of Urology, VCU Health System, Richmond, VA, USA; 2 Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USA; 3 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4 Swedish Urology Group, Seattle, WA, USA; 5 Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; 6 Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; 7 Orsi Academy, Melle, Belgium; 8 Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; 9 Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; 10 Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy; 11 Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 12 Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA; 13 Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China; 14 Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA, USA; 15 Department of Urology, University of Florence, Florence, Italy; 16 Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; 17 Division of Urology, IRCCS European Institute of Oncology (IEO), Milan, Italy; 18 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

BACKGROUND: Radical nephroureterectomy (RNU) represents the standard of care for high grade upper tract urothelial carcinoma (UTUC). Open and laparoscopic approaches are well-established treatments, but evidence regarding robotic RNU is growing. The introduction of the Xi® system facilitates the implementation of this multi-quadrant procedure. The aim of this video-article is to describe the surgical steps and the outcomes of Xi® robotic RNU.
METHODS: Single stage Xi® robotic RNU without patients repositioning and robot re-docking were done between 2015 and 2019 and collected in a large worldwide multi-institutional study, the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST). Institutional review board approval and data share agreement were obtained at each center. Surgical technique is described in detail in the accompanying video. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed.
RESULTS: Overall, 148 patients were included in the analysis; 14% had an ECOG >1 and 68.2% ASA ≥3. Median tumor dimension was 3.0 (IQR:2.0-4.2) cm and 34.5% showed hydronephrosis at diagnosis. Forty-eight% were cT1 tumors. Bladder cuff excision and lymph node dissection were performed in 96% and 38.1% of the procedures, respectively. Median operative time and estimated blood loss were 215.5 (IQR:160.5-290.0) minutes and 100.0 (IQR: 50.0-150.0) mL, respectively. Approximately 56% of patients took opioids during hospital stay for a total morphine equivalent dose of 22.9 (IQR:16.0-60.0) milligrams equivalent. Post-operative complications were 26 (17.7%), with 4 major (2.7%). Seven patients underwent adjuvant chemotherapy, with median number of cycles of 4.0 (IQR:3.0-6.0).
CONCLUSIONS: Single stage Xi® RNU is a reproducible and safe minimally invasive procedure for treatment of UTUC. Additional potential advantages of the robot might be a wider implementation of LND with a minimally invasive approach.

KEY WORDS: Robotic surgery; Nephroureterectomy; Urologic neoplasms

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