title: Robotic distal ureterectomy with boari flap reconstruction for distal ureteral urothelial cancers: a single institutional pilot experience.
abstract: OBJECTIVE
  Low-grade urothelial tumors of the distal ureter historically can be managed by open distal ureterectomy and ureteral reimplantation with or without bladder reconstruction. In recent years, the da Vinci surgical robotic system (DSRS) (Intuitive Surgical Inc., Sunnyvale, CA) has being increasingly used to perform complex urologic cancer surgeries. In this article, we report first on two consecutive patients undergoing robotic distal ureterectomy and Boari flap reconstruction (RDUBF) for distal ureteral cancer.
  
  
  METHODS
  Two consecutive patients underwent RDUBF, both with a diagnosis of low-grade papillary neoplasm of a distal ureter at our institution between August 2008 and November 2008. Perioperative parameters were prospectively collected and analyzed following institutional review board approval.
  
  
  RESULTS
  Two patients, male and female (age, 70 and 71 years, respectively) were included in the study. In both the patients, RDUBF was completed transperitoneally without the need for open conversion. The operative time, estimated blood loss, time to hospital discharge, and time to stent removal for both patients were 270 and 220 minutes, 25 and 35 mL, and 2 days and 6 weeks, respectively. The percentage change in hematocrit following surgery was within 5% in all patients. There were no postoperative complications in both patients. Final pathology demonstrated low-grade carcinoma pT1NxMx and pTaNxMx papillary urothelial carcinoma with negative margins in both patients. A MAG3 (mercapto-acetyl-tri-glycine) renal scan at 3 months demonstrated prompt drainage in both patients. At a median follow-up of 6 months, the patients were alive with no signs of recurrent or metastatic disease on cystoscopic, cytologic, or radiologic follow-up.
  
  
  CONCLUSIONS
  RDUBF reconstruction is technically feasible with using DSRS in select patients with distal ureteral cancer without disease recurrence in the short term. A larger cohort, with long-term follow-up, is necessary to validate our results.
authors.affiliation: Division of Urology, Department of Surgery, University of Massachusetts Medical School, Worcester 01655, MA, USA.
authors.forename: Satya
authors.initials: S
authors.lastname: Allaparthi
authors.forename: Rajan
authors.initials: R
authors.lastname: Ramanathan
authors.forename: K C
authors.initials: KC
authors.lastname: Balaji
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010865:Pilot Projects; D019651:Plastic Surgery Procedures / Q000379:methods*; D012371:Robotics; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*; D019459:Urothelium / Q000473:pathology / Q000601:surgery*