First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique

Sparwasser, Peter; Epple, S; Thomas, Arun Z.; Dotzauer, Robert; Boehm, Katharina; Brandt, Maximilian Peter; Mager, René; Borgmann, Hendrik; Kamal, Mohamed M.; Kurosch, M.; Höfner, Thomas; Haferkamp, Axel; Tsaur, Igor

doi:10.1007/s00345-021-03920-1

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…Average console time for those undergoing rRN was 198 minutes, and one patient undergoing rRSN requiring open conversion for non-progression. Lastly, Sparwasser et al reported on five patients who underwent rRNU using a similar technique described in this current study ( 18 ). While mean operative time in that group was only 189 minutes compared to 233 minutes in our study, their average patient was not obese.…”

Section: Discussionmentioning

confidence: 56%

“…There have only been three publications to our knowledge on the use rRN ( 18 , 29 , 30 ). Rose et al reported on the use of the Da Vinci S platform to perform a retroperitoneal nephroureterectomy on two patients with a hybrid port technique ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, the kidney was separated off the superior and anterior attachments ( Figure 1H ), placed in a specimen bag, and extracted through an extension of the assistant port in a muscle sparing Gibson-type incision ( Figure 2 ). If performing a rRNU, after the nephrectomy portion is complete, the robot is rotated 180 degrees without patient repositioning and the dissection of the lower ureter and bladder cuff are performed using a 3-arm approach as previously described ( 18 ). A surgical drain was placed only if there was suspected leak after bladder cuff closure when performing a rRNU or if performing a rRSN for a chronically infected kidney.…”

Section: Methodsmentioning

confidence: 99%

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Technique and outcomes of robotic-assisted retroperitoneal radical nephrectomy

Stout,

Said,

Tracy

et al. 2023

Transl Androl Urol

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Background Robotic retroperitoneal partial nephrectomy (rRPN) has numerous advantages over transperitoneal surgery, including direct access to the renal hilum and posterior tumors, and avoidance of the peritoneal cavity in patients with a hostile abdomen. Although the use of the retroperitoneal approach has increased over the last decade, there is little literature on robotic retroperitoneal radical nephrectomy (rRRN), which has similar benefits over the transperitoneal approach. The aim of this study was to describe our technique for robotic retroperitoneal nephrectomy (rRN) and assess its feasibility and outcomes at a high-volume center. Methods A retrospective review of patients who underwent some form of rRN [rRRN, robotic retroperitoneal simple nephrectomy (rRSN), or robotic retroperitoneal nephroureterectomy (rRNU)] at a single institution between 2013 and 2023. Patient characteristics, operative data, and postoperative complication rates were assessed. The technique for rRN was detailed. Results A total of 13 renal units in 12 patients were included for analysis (7 rRRN, 5 rRSN, 1 rRNU). Median patient age was 64.0 years, and median body mass index (BMI) was 36.0 kg/m 2 . Indications for retroperitoneal surgery were prior abdominal surgery in all patients, including three with bowel diversions, super morbid central obesity in two patients, and a large ventral hernia in one patient. Median operative time was 213 minutes and median estimated blood loss (EBL) was 85 cc. Median postoperative length of stay (LOS) was 3 days, and only one patient experienced a Clavien-Dindo grade ≥3 complication within 90 days of surgery. Conclusions The retroperitoneal approach for robotic-assisted nephrectomy is feasible and associated with similar outcomes as the transperitoneal approach. This approach may prove beneficial in select patients with significant prior abdominal surgery including those who are morbidly obese.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Technique and outcomes of robotic-assisted retroperitoneal radical nephrectomy

Stout,

Said,

Tracy

et al. 2023

Transl Androl Urol

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“…Sparwasser et al published the first series of completely retroperitoneal robot-assisted radical nephroureterectomy (RRNU) [ 16 ], and subsequently compared this technique to the standard transperitoneal approach [ 17 ]. In this scenario, ports placement starts from the Petit’s triangle and then follows a line above the iliac crest ( Figure 2 ).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes

Franco,

Ditonno,

Feng

et al. 2023

Cancers

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The gold standard treatment for non-metastatic upper tract urothelial cancer (UTUC) is represented by radical nephroureterectomy (RNU). The choice of surgical technique in performing UTUC surgery continues to depend on several factors, including the location and extent of the tumor, the patient’s overall health, and very importantly, the surgeon’s skill, experience, and preference. Although open and laparoscopic approaches are well-established treatments, evidence regarding robot-assisted radical nephroureterectomy (RANU) is growing. Aim of our study was to perform a critical review on the evidence of the last 5 years regarding surgical techniques and outcomes of minimally invasive RNU, mostly focusing on RANU. Reported oncological and function outcomes suggest that minimally invasive RNU is safe and effective, showing similar survival rates compared to the open approach.

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“…Indeed, a major hurdle to this approach is difficulty in MP placement and subsequent instrument clashing, making the operation burdensome and difficult to replicate. Of note, at the time of publishing this article, there is only a single publication describing a completely retroperitoneal robotic NU with bladder cuff excision, authored by Sparwasser et al , who performed surgery on 5 patients using the daVinci Xi ( 11 ). Here, the patient was placed in a lateral flank position and the trocars were placed parallel to the costal arch, following a line mimicking Kocher’s incision, with subsequent balloon dilation used to create space to accommodate the different robotic arms.…”

Section: Introduction: the Challenges Faced By The Multi-port (Mp) Ro...mentioning

confidence: 99%

Application of the single-port robotic platform during radical nephroureterectomy for upper tract urothelial carcinoma: feasibility of the single-port robot in the multi-quadrant setting

Pellegrino,

Mima,

Crivellaro

2023

Transl Androl Urol

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Urothelial carcinoma of the upper tract (UTUC) is a malignancy that accounts for 5–10% of all urothelial carcinomas. Radical surgery is the primary treatment option due to the high rate of invasive stages at the time of diagnosis. Nephroureterectomy (NU) with bladder cuff excision is the current standard of care. While laparoscopic NU has been established since 1991, many centres still perform open surgery due to the complexity of laparoscopic instrumentation and the steep learning curve for excising the bladder cuff. With the increasing adoption of the multi-port (MP) robotic surgery, NU has increasingly been performed using this platform. The use of MP robotic systems for NU has been challenged by the need for patient repositioning and/or redocking of the robot, which can consume valuable operative time. The transition from the daVinci Si to the daVinci Xi system has seen a noticeable reduction in redocking and patient repositioning. However, owing to the multi-quadrant nature of the surgery in question, the use of multiple ports and external instrument clashing are still persistent problems. Moreover, there is a growing interest in utilizing a retroperitoneal approach for robot-assisted NU due to its potential benefits such as improved control of hilar structures, reduction of blood loss, shorter operative time and hospital stay, reduced complications and decreased postoperative discomfort. The application of the daVinci single-port (SP) robotic platform during radical NU for UTUC is feasible and has the potential to improve the current surgical approach. Indeed, the use of a SP platform may solve the problem of patient repositioning and redocking of the robot, improve superficial aesthetic outcome and minimize external instrument clashing. While maintaining an optimal oncological control, the retroperitoneal approach, which has been difficult to replicate and adopt using the MP approach, may become standard practice. However, more studies are needed to confirm the benefit of this approach and ultimately determine the impact of the daVinci SP on the management of UTUC.

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First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique

Cited by 12 publications

References 24 publications

Technique and outcomes of robotic-assisted retroperitoneal radical nephrectomy

Technique and outcomes of robotic-assisted retroperitoneal radical nephrectomy

Minimally Invasive Radical Nephroureterectomy: 5-Year Update of Techniques and Outcomes

Application of the single-port robotic platform during radical nephroureterectomy for upper tract urothelial carcinoma: feasibility of the single-port robot in the multi-quadrant setting

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