title: Robotic distal ureterectomy with reimplantation in malignancy: technical nuances.
abstract: OBJECTIVE
  To present the point of technique of robotic distal ureterectomy under cystoscopic guidance with pelvic lymphadenectomy (PLND), ureteral reconstruction with and without a psoas hitch in patients with distal ureteral urothelial cancer (DUCC) and to review the current literature.
  
  
  METHODS
  The various steps of operative technique of robotic PLND, distal ureterectomy under cystoscopic guidance, ureteral reconstruction with and without a psoas hitch in patients of DUCC are described. Several tricks have been highlighted to undertake such procedure. The published English literature was also searched using the key words; robot, laparoscopy, ureteral reimplantation, distal ureterectomy, psoas hitch, and ureteroneocystostomy; so as to provide an up to date review on subject.
  
  
  RESULTS
  The technique robotic pelvic lymphadenectomy, distal ureterectomy, ureteral reimplantation with and without a psoas hitch in patients with DUCC was successful in both our patients. The mean operating room time, robotic (console) time, mean estimated blood loss and mean hospital stay were 250 min, 130 min, 150 cc and 2.2 days respectively. There were no complications.
  
  
  CONCLUSIONS
  The technique of robotic distal ureterectomy with ureteral reimplant for malignant ureteral strictures continues to be in evolution. Surgeon should be versatile with various options and technical nuances while dealing with these cases. The short term oncologic outcomes appear to be satisfactory and encouraging, while the long term results are awaited.
authors.affiliation: Department of Urology, Wake Forest University Medical School and Baptist Medical Centre, Winston Salem, NC 27157, USA.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Singh
authors.forename: Karim
authors.initials: K
authors.lastname: Kader
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000368:Aged; D003558:Cystoscopy; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012092:Replantation; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000601:surgery*