V1271: Technique of Robotic Assisted Nephroureterectomy with Bladder Cuff Excision: No Patient or Robot Repositioning Necessary

Video

Introduction and Objectives
Nephroureterectomy is the gold standard approach to the management of upper tract transitional cell carcinoma (TCC). The difficulty with the minimally invasive approach to this procedure including robotic nephroureterectomy stems from the how one manages the bladder cuff. Full cuff excision with bladder reconstruction allows for the best oncologic control, however requires repositioning and re-docking of the robot. In this video we describe a simple and effective technique to accomplish a nephroureterectomy with full bladder cuff excision and reconstruction without repositioning or re-docking that can easily standardized into practice.

Methods
Between January 2012 to October 2012 we retrospectively reviewed our robotic oncology database for all patients undergoing robotic nephroureterectomy for a diagnosis of upper tract TCC. All patients underwent full bladder cuff excision and bladder reconstruction using the robot. We describe a technique of switching robotic instruments between arms that helps facilitate distal ureteral dissection and bladder cuff excision with reconstruction without repositioning of the patient or re-docking of the robot.

Results
A total of 10 patients were identified who underwent robotic nephroureterectomy. All patients had full bladder cuff excision with reconstruction without repositioning or re-docking. The average age of patients was 80.5 (71-89). The average estimated blood loss (EBL) was 77.5ml and the average operative time was 146min. No intraoperative complications were encountered. One patient had a focal positive margin at the distal ureter. On final pathology 70% of patients had Ta or T1 disease.

Conclusions
Robotic nephroureterectomy with full bladder cuff excision and reconstruction can be done safely and efficiently without repositioning or robot re-docking. The procedure can be easily standardized with a minimal learning curve to overcome.

Funding: none