Abstract：Objective： To investigate the feasibility of single-docking robotic assisted laparoscopic long segmental urethrectomy with Boari flap and review our experience. Methods： A retrospective analysis on 7 patients with ureteral neoplasms, ureteral stenosis from 2017 to 2019 was performed. Statistics data included height, body mass index （BMI）, preoperative and postoperative serum creatinine value, operation time, estimated blood loss, etc. Results： All patients underwent robotic urethrectomy by single-docking, and the docking patient cart took （10.29 ± 2.03） min. The length of excised ureter was （11.14 ± 2.92） cm （8-15 cm）. Mean operative time was （110.71 ± 15.66） min. The estimated blood loss was （128.57 ± 15.66） mL. Surgical management did not reveal significant differences according to renal function. The serum creatinine was （110.86 ± 20.51） μmol/L preoperatively, （92.72 ± 12.81） μmol/L within 3 days after operation, and （94.38 ± 6.8） μmol/L at 6th month after operation. There was no significant difference in creatinine before and three days and 6 months after operation. During the follow-up period, there was one case of ureteral re-stenosis, 2 patients with tumors had distant metastases, and one had intravesical recurrence. Conclusion： Single-docking robotic assisted laparoscopic long segmental ureterectomy with Boari flap can be used in the case of proximal or middle ureteral tumors and stenosis, which can ensure the scope of the operation without re-position of patients.
[1] OU YC, HU CY, CHENG HL, et al.Long-term outcomes of total ureterectomy with ileal-ureteral substitution treatment for ureteral cancer: a single-center experience. BMC Urol, 2018,18(1):73.
[2] JIA Z, GONG YQ, ZHANG CJ, et al.Segmental ureterectomy can be performed safely in patients with urothelial carcinoma of distal ureter. Can Urol Assoc J, 2018,13(7):e202-e209.
[3] DO M, KALLIDONIS P, QAZI H, et al.Robot-assisted technique for boari flap ureteral reimplantation: is robot assistance beneficial? J Endourol, 2014,28(6):679-685.
[4] NEZHAT C, NEZHAT F, GREEN B.Laparoscopic treatment of obstructed ureter due to endometriosis by resection and ureteroureterostomy: a case report. J Urol, 1992,148(3):865-868.
[5] KOLONTAREV K, KASYAN G, PUSHKAR D.Robot-assisted laparoscopic ureteral reconstruction: а systematic review of literature. Cent European J Urol, 2018,71(2):221-227.
[6] MUFARRIJ PW, SHAH OD, BERGER AD, et al.Robotic reconstruction of the upper urinary tract. J Urol, 2007,178(5):2002-2005.
[7] PATIL NN, MOTTRIE A, SUNDARAM B, et al.Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation. Urology, 2008,72(1):47-50.
[8] SIEGEL RL, MILLER KD,JEMAL A. Cancer statistics, 2016. CA Cancer J Clin, 2016,66(1):7-30.
[9] ROUPRêT M, BABJUK M, BURGER M, et al. EAU Guidelines on Upper Urinary Tract Urothelial Carcinoma 2020, in European Association of Urology Guidelines. 2020 Edition. 2020, European Association of Urology Guidelines Office: Arnhem, The Netherlands.
[10] SEISEN T, PEYRONNET B, DOMINGUEZ-ESCRIG JL, et al.Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: a Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel. Eur Urol, 2016, 70(6): 1052-1068.
[11] LANE BR, SMITH AK, LARSON BT, et al.Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer, 2010,116(12): 2967-2973.
[12] KAAG MG, O'MALLEY RL, O'MALLEY P, et al. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol, 2010,58(4): 581-587.
[13] SEISEN T, GRANGER B, COLIN P, et al.A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma. Eur Urol, 2015,67(6): 1122-1133.
[14] HEMAL AK, NAYYAR R, GUPTA NP, et al.Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies. Urology, 2010,76(6): 1387-1393.
[15] YE H, FENG X, WANG Y, et al.Single-docking robotic-assisted nephroureterectomy and extravesical bladder cuff excision without intraoperative repositioning: The technique and oncological outcomes. Asian J Surg, 2020.
[16] ZARGAR H, KRISHNAN J, AUTORINO R, et al.Robotic nephroureterectomy: a simplified approach requiring no patient repositioning or robot redocking. Eur Urol, 2014. 66(4): 769-777.
[17] VAN DER SCHANS EM, HIEP MAJ, CONSTEN ECJ, et al. From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot. J Robot Surg, 2020.
