Techniques and Outcomes of Robot-assisted Nephro-ureterectomy for Upper Tract Urothelial Carcinoma

Radical nephro-ureterectomy and bladder cuff excision (RNUBCE) is the gold standard treatment for upper tract urothelial carcinoma (UTUC). RNUBCE can be performed via an open, laparoscopic or approach. The primary objective of this narrative mini-review is to report the techniques and outcomes for RNUBCE in the published literature. Relevant articles were selected utilizing the following search categories: robot nephro-ureterectomy, robot-assisted nephro-ureterectomy, and robot upper tract urothelial carcinoma. Different techniques in terms of patient positioning, port placement, lymph node dissection, and bladder cuff excision have been reported in the literature. Despite these varied techniques, perioperative outcomes of laparoscopic RNUBCE are favorable. In all, a total of 204 patients underwent RNUBCE, with a mean operating room time of 229.7min, mean blood loss of 189ml, and mean length of stay of 3.65 d. Further studies are needed to validate oncologic outcomes. PATIENT SUMMARY: Patients with high-risk upper tract urothelial carcinoma require complete removal of the kidney, ureter, and bladder cuff, along with a lymph node dissection. Although the procedure can be performed via an open approach, minimally-invasive surgery represents an alternative. Herein, we describe the techniques and outcomes of radical nephro-ureterectomy and bladder cuff excision.