Effectiveness and Safety of Robotic-Assisted One-Step Radical Nephroureterectomy

Overview

This retrospective study analyzed 69 patients undergoing robotic-assisted laparoscopic one-step radical nephroureterectomy (RNU) with bladder cuff excision (BCE) for upper tract urothelial carcinoma (UTUC). The procedure demonstrated efficacy in tumor control and safety with minimized trauma and accelerated recovery.

Background

Upper tract urothelial carcinoma (UTUC) is a rare but aggressive uroepithelial cancer often diagnosed at advanced stages. Standard treatment involves radical nephroureterectomy (RNU) with bladder cuff excision (BCE) to ensure complete tumor removal and reduce recurrence risk. Traditional open surgery is invasive with prolonged recovery, while laparoscopic approaches face challenges in tumor control. Robotic-assisted laparoscopic surgery offers a minimally invasive alternative with improved precision and recovery.

Data Highlights

Key Findings

• Robotic-assisted one-step RNU with BCE was successfully performed in 69 patients without intraoperative repositioning or robot redocking.
• The surgical technique allowed complete resection of the kidney, ureter, and bladder cuff with precise tumor control.
• Patients were positioned in a 45° semirecumbent posture facilitating access and minimizing trauma.
• Use of barbed sutures enabled secure bladder closure after cuff excision.
• The procedure minimized surgical trauma compared to open surgery and avoided the technical challenges of conventional laparoscopy.
• All surgeries were performed by an experienced surgeon, ensuring procedural consistency and safety.

Clinical Implications

Robotic-assisted laparoscopic one-step RNU with bladder cuff excision offers a safe and effective minimally invasive option for high-risk UTUC patients. This approach reduces operative trauma and recovery time while maintaining oncological principles of complete tumor resection. Surgeons experienced in robotic techniques can adopt this method to optimize patient outcomes.

Conclusion

Robotic-assisted laparoscopic one-step radical nephroureterectomy with bladder cuff excision is a feasible and safe surgical approach that ensures effective tumor control with reduced patient morbidity. It represents a valuable advancement in the management of upper tract urothelial carcinoma.

References

1. Hemal et al. 2011 -- Robotic nephroureterectomy with bladder cuff excision without repositioning
2. Zargar et al. 2014 -- Simplified one-step robot-assisted radical nephroureterectomy