V06-12: Robotic-Assisted Laparoscopic Right Nephroureterectomy: Making Urology Retroperitoneal Again
Transperitoneal nephroureterectomy is a common treatment strategy for high-grade upper tract urothelial carcinoma (UTUC). However, this approach is often complicated for patients with extensive peritoneal adhesions. A minimally invasive technique that avoids entry into the peritoneal cavity may provide an alternative treatment option for patients with significant abdominal surgical histories. We sought to demonstrate the feasibility of a retroperitoneoscopic nephroureterectomy by utilizing a robotic-assisted laparoscopic approach in a 62-year-old male with right, high-grade UTUC and complex midline abdominal incisions.
We performed a right retroperitoneal nephroureterectomy utilizing the da Vinci Xi surgical robot. The key surgical steps included: retroperitoneal access and port placement, ligation of renal hilum, complete kidney mobilization, preservation of adrenal gland, 180 degree robotic rotation with completion of ureteral dissection and bladder cuff formation.
Successful minimally invasive surgical operation without complications. Final pathology demonstrated a high-grade 5.5 cm UTUC involving the kidney parenchyma with negative margins. Hospital length of stay was 3 days.
A robotic retroperitoneoscopic nephroureterectomy is a feasible minimally invasive approach for high-grade UTUC and may be especially valuable for patients with multiple intra-abdominal surgeries that preclude a traditional transperitoneal approach.