TY - JOUR
T1 - Single-stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma
T2 - surgical technique and outcomes
AU - Veccia, Alessandro
AU - Carbonara, Umberto
AU - Der Weesh, Ithaar
AU - Mehraziz, Reza
AU - Porter, James
AU - Abdollah, Firas
AU - Mazzone, Elio
AU - Sundaram, Chandru P.
AU - Gonzalgo, Mark
AU - Mastroianni, Riccardo
AU - Ghoreifi, Alireza
AU - Cacciamani, Giovanni E.
AU - Patel, Devin
AU - Marcus, Jamil
AU - Danno, Alyssa
AU - Steward, James
AU - Bhattu, Amit Satish
AU - Asghar, Aeen
AU - Reese, Adam C.
AU - Wu, Zhenjie
AU - Uzzo, Robert G.
AU - Minervini, Andrea
AU - Rha, Koon H.
AU - Ferro, Matteo
AU - Margulis, Vitaly
AU - Hampton, Lance J.
AU - Simone, Giuseppe
AU - Eun, Daniel D.
AU - Djaladat, Hooman
AU - Mottrie, Alexandre
AU - Autorino, Riccardo
N1 - Publisher Copyright:
© The Author(s), 2022.
PY - 2022/4
Y1 - 2022/4
N2 - 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. (Cite this article as: Veccia a, Carbonara U, derweesh i, Mehrazin r, porter J, abdollah F, et al. Single-stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes. Minerva Urol Nephrol 2022;74:233-41. doi: 10.23736/S2724-6051.21.04247-8)
AB - 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. (Cite this article as: Veccia a, Carbonara U, derweesh i, Mehrazin r, porter J, abdollah F, et al. Single-stage Xi® robotic radical nephroureterectomy for upper tract urothelial carcinoma: surgical technique and outcomes. Minerva Urol Nephrol 2022;74:233-41. doi: 10.23736/S2724-6051.21.04247-8)
KW - Nephroureterectomy
KW - Urologic neoplasms
KW - robotic surgery
UR - http://www.scopus.com/inward/record.url?scp=85117232920&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117232920&partnerID=8YFLogxK
U2 - 10.23736/S2724-6051.21.04247-8
DO - 10.23736/S2724-6051.21.04247-8
M3 - Article
C2 - 33781022
AN - SCOPUS:85117232920
SN - 2724-6051
VL - 74
SP - 233
EP - 241
JO - Minerva Urology and Nephrology
JF - Minerva Urology and Nephrology
IS - 22
ER -