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Minerva Urology and Nephrology 2021 Mar 29

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, Chandru P. SUNDARAM 7, Mark GONZALGO 8, Riccardo MASTROIANNI 9, Alireza GHOREIFI 10, Giovanni E. CACCIAMANI 10, Devin PATEL 2, Jamil MARCUS 5, Alyssa DANNO 5, James STEWARD 7, Amit S. BHATTU 8, Aeen ASGHAR 11, Adam C. REESE 11, Zhenjie WU 12, Robert G. UZZO 13, Andrea MINERVINI 14, Koon H. RHA 15, Matteo FERRO 16, Vitaly MARGULIS 17, Lance J. HAMPTON 1, Giuseppe SIMONE 9, Daniel D. EUN 11, Hooman DJALADAT 10, Alexandre MOTTRIE 6, 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 Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; 8 Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; 9 Department of Urology, Regina Elena National Cancer Institute, Rome, Italy; 10 Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 11 Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA; 12 Department of Urology, Changzheng Hospital, Second Military (Naval) Medical University, Shanghai, China; 13 Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA, USA; 14 Department of Urology, University of Florence, Florence, Italy; 15 Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea; 16 Division of Urology, European Institute of Oncology, Milan, Italy; 17 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 RANU 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.
RESULTSː 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. Postoperative complications were 26 (17.7%), with 4 major (15.4%). 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; Nephroureterectomy; Upper tract urothelial carcinoma

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