Robotic radical nephro-ureterectomy for high-risk upper tract urothelial carcinoma: Step-by-step illustrative video of surgical technique

Abstract

The gold standard treatment offered to patients with high-risk upper tract urothelial carcinoma (UTUC) is radical nephro-ureterectomy (RNU). The procedure may be performed open, laparoscopic or with robotic assistance. Herein, we describe our technique of performing robot-assisted RNU. We retrospectively reviewed patients who underwent RNU for high-risk UTUC from January 2006 to June 2017. Sociodemographic, preoperative, intraoperative, perioperative, outcomes, and pathologic data were recorded. A total of 90 patients with a mean age of 70.9 and BMI 27.4 underwent robot-assisted RNU with a minimum of 12 month follow-up. Average operative time was 215 min with a mean estimated blood loss of 140 mL. 37% of patients were diagnosed with pT3 or greater disease with a pN+ rate of 17%. We report a 4% Clavien ≥ 3 complication rate. 5-year overall survival and cancer-specific survival were 42% and 58%, respectively. Robot-assisted RNU is an efficacious and technically feasible operation that affords advantages over standard laparoscopic or open approaches. Regardless of approach, sound oncologic principles should be emphasized.