title: Robot-assisted ureterectomy and ureteral reconstruction for urothelial carcinoma.
abstract: 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.
authors.affiliation: Department of Urologic Oncology, Roswell Park Cancer Institute and State University of New York, Buffalo, New York 14263, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Glinianski
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
authors.forename: Greg
authors.initials: G
authors.lastname: Zimmerman
authors.forename: James
authors.initials: J
authors.lastname: Mohler
authors.forename: Hyung L
authors.initials: HL
authors.lastname: Kim
mesh_terms: 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*