Objective• 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. Patients and Methods• Between May 2007 and July 2011, 43 RANU were performed at three institutions for UUTUC with review of perioperative outcomes. • 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.• Single and two robot-docking techniques are described. Results• 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.• Pathology was pTa in nine patients, pT1 in 14 patients, pT2 in three patients, pT3 in 15 patients and pT4 in two patients.• Lymph node dissection was performed in 22 patients (51%) with a mean (range) lymph node count of 11 (4-23).• 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).• 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. Conclusions• RANU is a feasible alternative to laparoscopic and open techniques.• Particular steps of the operation including sutured closure of the cystotomy and regional lymphadenectomy are facilitated with the use of robot-assisted surgery.• Long-term outcomes are necessary to assess the relative efficacy of these approaches to more established techniques; however, early perioperative outcomes appear promising.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for removing large, complex, and/or multiple renal calculi. Since its first description in 1976, PCNL techniques and equipment have evolved to maximize procedural efficacy, safety, and reproducibility. We reviewed current literature from January 2004 to November 2009 using Medline search regarding PCNL instrumentation and technology. Additional equipment discovered during the review process without published Medline evidence was summarized from manufacturer brochures and data. Included in this review are summaries of intracorporeal lithotriptors and accessory equipment, stone manipulation devices, PCNL tract sealants, and a digital rigid nephroscope. The evolution of these devices from their predecessors has increased the instrumentation options for the treating urologist and may represent more effective technology for the percutaneous treatment of large renal stones.

Use of the da Vinci® surgical robotic system has expanded to numerous upper and lower urinary tract procedures. We describe our surgical technique and perioperative outcome of robotic distal ureterectomy with psoas hitch and ureteroneocystostomy for distal ureteral pathologies. Eight patients with a median age of 69.5 years old underwent robotic distal ureterectomy with psoas hitch and ureteroneocystostomy between April 2009 and August 2014. The entirety of all cases was performed robotically by a single surgeon at a tertiary academic medical center. Median operative time was 285 min (range: 210–360 min), estimated blood loss was 50 mL (range: 50–75 mL) and median length of hospital stay was 2.5 days (range: 1–6 days). There was one post-operative complication, a readmission for dehydration (Clavien I). It suggests that robotic distal ureterectomy with psoas hitch and ureteroneocystostomy is a safe and effective minimally invasive alternative for patients with distal ureteral pathology.

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