Initial experience of robotic nephroureterectomy: a hybrid-port technique.
OBJECTIVE
To report a new technique of robot-assisted laparoscopic nephroureterectomy (RANU) using a hybrid port, as RANU has recently become a minimally invasive treatment option for upper tract transitional cell carcinoma (TCC).


METHODS
Eleven consecutive patients underwent RANU by one surgeon. The first six patients were repositioned after the nephrectomy, from flank to lithotomy position, and the robot was re-docked for excision of the distal ureter and bladder cuff. The last five patients were treated by a new RANU technique that did not require a change of position or movement of the patient cart. We analysed data obtained before, during and after RANU.


RESULTS
The total operative duration was reduced by approximately 50 min in last five patients. There was no improvement in hospital stay or estimated blood loss. There were no transfusions and positive surgical margins in any patient. Maintaining the patient in a flank position allows gravity to displace the bowel away from the distal ureter, not only shortening the surgery but also improving exposure of the distal ureterectomy and closure of the bladder cuff.


CONCLUSIONS
The new RANU technique is a safe and feasible treatment option for upper tract TCC.
Park
Sung Yul
SY
Department of Urology, Yonsei University College of Medicine, Urological Science Institute, and Hanyang University College of Medicine, Seoul, Korea.
Jeong
Wooju
W
Ham
Won Sik
WS
Kim
Won Tae
WT
Rha
Koon Ho
KH
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*