Pellegrino Antony A, Mima Mahmoud, Crivellaro Simone
Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Transl Androl Urol. 2023 Sep 30;12(9):1469-1474. doi: 10.21037/tau-23-48. Epub 2023 Aug 16.
Urothelial carcinoma of the upper tract (UTUC) is a malignancy that accounts for 5-10% of all urothelial carcinomas. Radical surgery is the primary treatment option due to the high rate of invasive stages at the time of diagnosis. Nephroureterectomy (NU) with bladder cuff excision is the current standard of care. While laparoscopic NU has been established since 1991, many centres still perform open surgery due to the complexity of laparoscopic instrumentation and the steep learning curve for excising the bladder cuff. With the increasing adoption of the multi-port (MP) robotic surgery, NU has increasingly been performed using this platform. The use of MP robotic systems for NU has been challenged by the need for patient repositioning and/or redocking of the robot, which can consume valuable operative time. The transition from the daVinci Si to the daVinci Xi system has seen a noticeable reduction in redocking and patient repositioning. However, owing to the multi-quadrant nature of the surgery in question, the use of multiple ports and external instrument clashing are still persistent problems. Moreover, there is a growing interest in utilizing a retroperitoneal approach for robot-assisted NU due to its potential benefits such as improved control of hilar structures, reduction of blood loss, shorter operative time and hospital stay, reduced complications and decreased postoperative discomfort. The application of the daVinci single-port (SP) robotic platform during radical NU for UTUC is feasible and has the potential to improve the current surgical approach. Indeed, the use of a SP platform may solve the problem of patient repositioning and redocking of the robot, improve superficial aesthetic outcome and minimize external instrument clashing. While maintaining an optimal oncological control, the retroperitoneal approach, which has been difficult to replicate and adopt using the MP approach, may become standard practice. However, more studies are needed to confirm the benefit of this approach and ultimately determine the impact of the daVinci SP on the management of UTUC.
上尿路尿路上皮癌（UTUC）是一种恶性肿瘤，占所有尿路上皮癌的5%-10%。由于诊断时侵袭性分期的发生率较高，根治性手术是主要的治疗选择。肾输尿管切除术（NU）加膀胱袖口切除术是目前的标准治疗方法。虽然自1991年以来就已开展腹腔镜NU手术，但由于腹腔镜器械的复杂性以及切除膀胱袖口的学习曲线较陡，许多中心仍采用开放手术。随着多端口（MP）机器人手术的日益普及，NU越来越多地在这个平台上进行。MP机器人系统用于NU手术受到患者重新定位和/或机器人重新对接的挑战，这可能会消耗宝贵的手术时间。从达芬奇Si系统过渡到达芬奇Xi系统后，重新对接和患者重新定位明显减少。然而，由于该手术涉及多个象限，使用多个端口以及外部器械冲突仍然是持续存在的问题。此外，由于其潜在的益处，如更好地控制肾门结构、减少失血、缩短手术时间和住院时间、减少并发症以及减轻术后不适，越来越多的人对采用腹膜后途径进行机器人辅助NU手术感兴趣。在根治性NU手术中应用达芬奇单端口（SP）机器人平台治疗UTUC是可行的，并且有可能改善当前的手术方法。事实上，使用SP平台可能解决患者重新定位和机器人重新对接的问题，改善表面美观效果，并最大限度地减少外部器械冲突。在维持最佳肿瘤学控制的同时，腹膜后途径一直难以通过MP途径复制和采用，可能会成为标准术式。然而，需要更多的研究来证实这种方法的益处，并最终确定达芬奇SP平台对UTUC治疗的影响。
