Prone retroperitoneal robotic-assisted laparoscopic radical nephroureterectomy with bladder cuff excision in single position: techniques and outcomes.

Conventional robotic-assisted laparoscopic radical nephroureterectomy (RARNU) with bladder cuff excision (BCE) often requires changes in patient position, trocar placement, or robotic docking, increasing procedural complexity. Retroperitoneal single-position surgeries are rare and primarily focus on lateral and supine positions, which still present constraints. This study aims to investigate the safety and the feasibility of prone retroperitoneal RARNU (prRARNU) with BCE in single position, and to compare the results with clinical data on retroperitoneal RARNU (rRARNU) reported in the literature. From August 2023 to April 2024, four patients [mean age: 68.8 years; BMI: 24.3 kg/m] with upper urinary tract urothelial carcinoma (UTUC) underwent prRARNU with BCE. Demographic, perioperative, and follow-up data were collected. Two patients had American Society of Anesthesiology score ≥ 3. All surgeries were successfully completed without open surgery conversions and blood transfusions. Mean operation time was (165 ± 6.7) minutes, estimated blood loss was (87.5 ± 41.5) mL, intraoperative PaCO was (39.5 ± 3.0) mmHg, drainage tube removal time was (3.3 ± 0.4) days, postoperative hospital stay was (3.8 ± 0.8) days, and postoperative 3-dayHb and eGFR decreased by (11.3 ± 4.0) g/L and (13.1 ± 20.5) mL/min/1.73 m respectively. After a median follow-up of 15.1 months, the mean eGFR at postoperative month 3 was (45.2 ± 15.9) mL/min/1.73 m, with no complications or tumor recurrence. One patient died of acute heart failure unrelated to UTUC. Compared to published data on rRARNU, prRARNU with BCE demonstrated satisfactory outcomes, suggesting its safety, feasibility, with short operation time, and quick recovery.