Initial experience with robot-assisted minimally-invasive nephroureterectomy

Jim C. Hu, Joseph P. Silletti, Stephen Williams

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Purpose: Various techniques have been described for laparoscopic nephroureterectomy. We reviewed our initial experience of laparoscopic nephroureterectomy with robot-assisted extravesical excision of the distal ureter and bladder cuff. Materials and Methods: Nine consecutive patients aged 43 to 83 years underwent laparoscopic nephroureterectomy for transitional cell carcinoma (TCC) between August 2005 and March 2007. The first five patients were repositioned after laparoscopic nephrectomy from flank to lithotomy position to dock the robot for excision of the distal ureter and bladder cuff by a single surgeon. In contrast, the last four patients remained in flank position throughout the entire procedure, with the robot docked in flank position following laparoscopic nephrectomy. A two-layer closure re-approximated the cystotomy and a urethral catheter was left in place for a mean of 5 days. Results: Eight men and one woman with a mean age of 64.2 years and mean body mass index (BMI) of 28.4 kg/m 2 underwent flexible cystoscopy and laparoscopic nephroureterectomy for five right-sided and four left-sided tumors. Mean operative time was 303 minutes (range 210-430 minutes), estimated blood loss was 211 mL (range 50-700 mL), and mean length of hospital stay was 2.3 days. Pathologic staging revealed T 3 for five (55.6%), T a for two (22.2%), carcinoma in situ (CIS) for two (22.2%) patients, and high-grade disease for seven (77.8%) patients. With a mean follow-up of 16.2 months (range 4.3-24.3 months), three patients with a history of bladder cancer have experienced recurrence in the bladder, and one of the three has also developed metastatic disease. Conclusions: Laparoscopic nephroureterectomy with robot-assisted extravesical excision of the distal ureter and bladder cuff appears to be a feasible alternative for patients with TCC of the upper urinary tract.

Original languageEnglish (US)
Pages (from-to)699-704
Number of pages6
JournalJournal of Endourology
Volume22
Issue number4
DOIs
StatePublished - Apr 1 2008
Externally publishedYes

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Urinary Bladder
Ureter
Transitional Cell Carcinoma
Nephrectomy
Length of Stay
Cystotomy
Urinary Catheters
Cystoscopy
Carcinoma in Situ
Operative Time
Urinary Tract
Urinary Bladder Neoplasms
Body Mass Index
Recurrence
Neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Initial experience with robot-assisted minimally-invasive nephroureterectomy. / Hu, Jim C.; Silletti, Joseph P.; Williams, Stephen.

In: Journal of Endourology, Vol. 22, No. 4, 01.04.2008, p. 699-704.

Research output: Contribution to journalArticle

Hu, Jim C. ; Silletti, Joseph P. ; Williams, Stephen. / Initial experience with robot-assisted minimally-invasive nephroureterectomy. In: Journal of Endourology. 2008 ; Vol. 22, No. 4. pp. 699-704.
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abstract = "Purpose: Various techniques have been described for laparoscopic nephroureterectomy. We reviewed our initial experience of laparoscopic nephroureterectomy with robot-assisted extravesical excision of the distal ureter and bladder cuff. Materials and Methods: Nine consecutive patients aged 43 to 83 years underwent laparoscopic nephroureterectomy for transitional cell carcinoma (TCC) between August 2005 and March 2007. The first five patients were repositioned after laparoscopic nephrectomy from flank to lithotomy position to dock the robot for excision of the distal ureter and bladder cuff by a single surgeon. In contrast, the last four patients remained in flank position throughout the entire procedure, with the robot docked in flank position following laparoscopic nephrectomy. A two-layer closure re-approximated the cystotomy and a urethral catheter was left in place for a mean of 5 days. Results: Eight men and one woman with a mean age of 64.2 years and mean body mass index (BMI) of 28.4 kg/m 2 underwent flexible cystoscopy and laparoscopic nephroureterectomy for five right-sided and four left-sided tumors. Mean operative time was 303 minutes (range 210-430 minutes), estimated blood loss was 211 mL (range 50-700 mL), and mean length of hospital stay was 2.3 days. Pathologic staging revealed T 3 for five (55.6{\%}), T a for two (22.2{\%}), carcinoma in situ (CIS) for two (22.2{\%}) patients, and high-grade disease for seven (77.8{\%}) patients. With a mean follow-up of 16.2 months (range 4.3-24.3 months), three patients with a history of bladder cancer have experienced recurrence in the bladder, and one of the three has also developed metastatic disease. Conclusions: Laparoscopic nephroureterectomy with robot-assisted extravesical excision of the distal ureter and bladder cuff appears to be a feasible alternative for patients with TCC of the upper urinary tract.",
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