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. 2024 Nov 1;24(1):238.
doi: 10.1186/s12894-024-01629-y.

Robotic surgery of the urothelial carcinoma of the upper urinary tract single surgeon initial experience, 66 consecutive cases

Mahmoud Farzat  1   2 , Sami-Ramzi Leyh-Bannurah  3 , Florian M Wagenlehner  4
Affiliations

Robotic surgery of the urothelial carcinoma of the upper urinary tract single surgeon initial experience, 66 consecutive cases

Mahmoud Farzat et al. BMC Urol. .

Abstract

Purpose: Robotic surgery is increasingly utilized in the treatment of urothelial carcinoma of the upper urinary tract (UTUC). This study investigates the advantages and burden of robot-assisted surgical treatment of the urothelial carcinoma of the upper urinary tract in a referral urological department, along with their functional and oncological results.

Methods: The study included 66 prospectively enrolled patients who were surgically treated by a single, robotically specialized surgeon between July 2019 and December 2023. Patients were divided into three groups. Group 1: 50 patients underwent robot-assisted radical Nephroureterectomy (RANU) with bladder cuff excision, Group 2: 11 patients underwent RANU simultaneously with robot-assisted radical cystectomy (RARC), and Group 3: 5 patients underwent robot-assisted segmental ureterectomy (RASU). Clinical and oncological parameters were compared. Perioperative morbidity according to Clavien-Dindo was the primary endpoint of our study. The secondary endpoint was oncologic outcomes.

Results: 37.8% of patients had locally advanced carcinomas. The average console time of RANU with bladder cuff excision was 69 min. The rate of positive surgical margins was n = 1/66 (2%). Lymphadenectomy (LAD) was performed on 30% of patients, with a mean of 13.7 lymph nodes removed. Of those who received LAD, 33% had lymph node metastasis. n = 6/66 (9%) patients received blood transfusion. The overall complication rate was 24%. The readmission rate was 7.5%. With a median follow-up of 26 months, the 2-year recurrence-free survival rate was 84.4%, and the 2-year overall survival rate was 94%.

Conclusion: Robotic surgery is a feasible option for treating UTUC that can be adapted to meet the surgical needs of each patient. Prospective studies are warranted to confirm its benefits.

Keywords: RANU; RARC; Segmental ureterectomy; Upper urinary tract carcinoma (UTUC).

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Conflict of interest statement

The authors declare no competing interests.

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