Single-stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes

Alessandro Veccia, Umberto Carbonara, Ithaar Derweesh, Reza Mehrazin, James Porter, Firas Abdollah, Elio Mazzone, Chandru P. Sundaram, Mark Gonzalgo, Riccardo Mastroianni, Alireza Ghoreifi, Giovanni E. Cacciamani, Devin Patel, Jamil Marcus, Alyssa Danno, James Steward, Amit Satish Bhattu, Aeen Asghar, Adam C. Reese, Zhenjie WuRobert G. Uzzo, Andrea Minervini, Koon H. Rha, Matteo Ferro, Vitaly Margulis, Lance J. Hampton, Giuseppe Simone, Daniel D. Eun, Hooman Djaladat, Alexandre Mottrie, Riccardo Autorino

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

BACKGROUND: Radical nephroureterectomy (RNU) represents the standard of care for high grade upper tract urothelial carcinoma (UTUC). Open and laparoscopic approaches are well-established treatments, but evidence regarding robotic RNU is growing. The introduction of the Xi® system facilitates the implementation of this multi-quadrant procedure. The aim of this video-article is to describe the surgical steps and the outcomes of Xi® robotic RNU. METHODS: Single stage Xi® robotic RNU without patients repositioning and robot re-docking were done between 2015 and 2019 and collected in a large worldwide multi-institutional study, the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST). Institutional review board approval and data share agreement were obtained at each center. Surgical technique is described in detail in the accompanying video. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed. RESULTS: Overall, 148 patients were included in the analysis; 14% had an ECOG >1 and 68.2% ASA ≥3. Median tumor dimension was 3.0 (IQR:2.0-4.2) cm and 34.5% showed hydronephrosis at diagnosis. Forty-eight% were cT1 tumors. Bladder cuff excision and lymph node dissection were performed in 96% and 38.1% of the procedures, respectively. Median operative time and estimated blood loss were 215.5 (IQR:160.5-290.0) minutes and 100.0 (IQR: 50.0-150.0) mL, respectively. Approximately 56% of patients took opioids during hospital stay for a total morphine equivalent dose of 22.9 (IQR:16.0-60.0) milligrams equivalent. Post-operative complications were 26 (17.7%), with 4 major (2.7%). Seven patients underwent adjuvant chemotherapy, with median number of cycles of 4.0 (IQR:3.0-6.0). CONCLUSIONS: Single stage Xi® RNU is a reproducible and safe minimally invasive procedure for treatment of UTUC. Additional potential advantages of the robot might be a wider implementation of LND with a minimally invasive approach.

Original languageEnglish (US)
Pages (from-to)233-241
Number of pages9
JournalMinerva Urology and Nephrology
Volume74
Issue number2
DOIs
StatePublished - Apr 1 2022
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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