Ji Qianying, Wang Jun, Zhao Tong, Zhang Yetao, Li Kai, Wei Yong, Zhu Qingyi
Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Asian J Urol. 2025 Apr;12(2):244-249. doi: 10.1016/j.ajur.2024.05.001. Epub 2024 Jul 14.
To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy (RLESS-RNU) with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma (UTUC).
Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution (The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China), from our prospectively maintained institutional database. The da Vinci® Xi system (Intuitive Surgical, Sunnyvale, CA, USA) was utilized for surgical procedures in all patients. An in-depth analysis was conducted on their baseline demographic characteristics, pathological factors, and perioperative details. The complete surgical process and details are elaborated.
The median age of 15 patients was 67 years. The final pathology demonstrated 47% (7/15) patients with pT1 or lower and 47% (7/15) with pT3; one patient could not undergo pathological staging because of preoperative chemotherapy. The perioperative outcomes revealed that the mean operative time was 185 (standard deviation [SD] 23.05) min. The mean times of the trocar placement for primary and second docking were 15.00 (SD 0.85) min and 8.00 (SD 0.52) min, respectively. The median estimated blood loss was 55 mL. The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days, respectively. After a mean follow-up period of 24.20 months, the relapse-free survival rate was 87%. Two patients experienced disease progression: one patient exhibited multifocal evidence of non-muscle invasive bladder cancer, and the other patient developed systemic recurrence.
This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.
介绍一种改良的机器人辅助腹腔镜单孔腹膜后肾输尿管切除术（RLESS-RNU）并切除膀胱袖口，评估其作为治疗上尿路尿路上皮癌（UTUC）的微创方法的有效性。
回顾了2020年4月至2021年6月期间在我院（南京医科大学第二附属医院，中国南京）接受RLESS-RNU治疗UTUC的15例患者，数据来自我们前瞻性维护的机构数据库。所有患者均使用达芬奇® Xi系统（直观外科手术公司，美国加利福尼亚州桑尼维尔）进行手术。对他们的基线人口统计学特征、病理因素和围手术期细节进行了深入分析。详细阐述了完整的手术过程和细节。
15例患者的中位年龄为67岁。最终病理显示，47%（7/15）的患者为pT1或更低分期，47%（7/15）为pT3；1例患者因术前化疗无法进行病理分期。围手术期结果显示，平均手术时间为185（标准差[SD] 23.05）分钟。初次和二次对接时套管针置入的平均时间分别为15.00（SD 0.85）分钟和8.00（SD 0.52）分钟。估计中位失血量为55毫升。引流管平均留置时间和术后住院时间分别为7.50天和11.00天。平均随访24.20个月后，无复发生存率为87%。2例患者出现疾病进展：1例患者表现为非肌层浸润性膀胱癌多灶证据，另1例患者发生全身复发。
本研究表明，改良的RLESS-RNU技术治疗UTUC安全且效果良好。
