title: The technique of single stage pure robotic nephroureterectomy.
abstract: OBJECTIVE
  To describe a novel technique for a single setup approach for robotic radical nephroureterectomy (RANU) that does not require patient repositioning, port reassignment, or redocking of the robotic arms.
  
  
  METHODS
  Twenty consecutive patients underwent RANU at a single institution between January 2009 and January 2012. We implemented a unique port placement strategy based on a modified paramedian line (MPL), which allowed sufficient access to both the upper abdomen and the deep pelvis for radical NU with bladder cuff excision and concomitant lymphadenectomy.
  
  
  RESULTS
  The mean operative time was 161.3 minutes (range 91-330 minutes), mean estimated blood loss was 98.8 (range 50-200), and the mean hospital stay was 3 days (median 2 days, range 1-16 days). None of the procedures were converted to open or required blood transfusions. Lymphadenectomy was performed on 16 out of 20 patients, and the mean number of lymph nodes removed per patient when lymphadenectomy was performed was 14.1 (range 2-35). Three patients had positive lymph nodes. One patient had prolonged postoperative ileus, and one had a hospital course that was complicated by pneumonia. Mean patient follow-up was 13.5 months (range 1-24 months); one patient was found to have a recurrence at 3 month follow-up.
  
  
  CONCLUSIONS
  The use of our MPL line for novel port placement allows for an effective, efficient, and reproducible method for RANU without the need for repositioning of the patient or the robot.
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Ziho
authors.initials: Z
authors.lastname: Lee
authors.forename: Ronald
authors.initials: R
authors.lastname: Cadillo-Chavez
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Elton
authors.initials: E
authors.lastname: Llukani
authors.forename: Daniel
authors.initials: D
authors.lastname: Eun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D012371:Robotics / Q000379:methods*; D014513:Ureter / Q000601:surgery*