Robot-assisted ureterectomy and ureteral reconstruction for urothelial carcinoma.
OBJECTIVE
Urothelial carcinoma of the distal ureter can be managed by ureterectomy followed by reconstruction of the urinary system. We review our experience with robot-assisted ureterectomy.


METHODS
Nine consecutive patients who were candidates for ureterectomy underwent robot-assisted surgery between 7/8/2005 and 7/25/2006. Patient characteristics, intraoperative parameters, and short-term outcomes were retrospectively reviewed.


RESULTS
Mean operative time was 252 minutes. The mean blood loss was 44 mL, and no patient needed a transfusion. The mean hospital stay was 1.5 days. Six patients needed a psoas hitch; one patient each underwent a primary ureteral anastomosis, a direct ureteral reimplant into the dome of the bladder, and distal ureterectomy for tumor in a ureteral stump after nephrectomy. The ureteral reimplant was performed intravesically in one patient and extravesically in five patients. A bladder cuff was excised in all patients who were undergoing a distal ureterectomy. All surgical margins were negative, and five patients had high-grade tumor. A ureteral stricture developed in one patient, and a patient experienced aspiration pneumonia in the postoperative period.


CONCLUSIONS
Robot-assisted ureterectomy and ureteral reconstruction is safe and feasible, and offers patients the advantages of minimally invasive surgery. Future studies with additional patients and longer follow-up will determine the oncologic effectiveness of this procedure.
Glinianski
Michal
M
Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York 14263, USA.
Guru
Khurshid A
KA
Zimmerman
Greg
G
Mohler
James
J
Kim
Hyung L
HL
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics; D013525:Surgical Instruments; D014513:Ureter / Q000473:pathology* / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery; D019459:Urothelium / Q000473:pathology* / Q000601:surgery*