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Robot-Assisted Radical Nephroureterectomy

  • Daniel Willis
  • Joseph Pugh
  • Sijo J. Parekattil
  • Hany Atalah
  • Li-Ming SuEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Radical nephroureterectomy with formal bladder cuff excision was first proposed in 1933 by Kimball and Ferris (J Urol 31: 257, 1933) for the treatment of papillomatous tumors of the renal pelvis and ureter. This approach has become standard of care for upper urinary tract neoplasms as many of these tumors are characterized by multifocality, high ipsilateral recurrence rates after partial resection, and low (<5%) incidence of contralateral disease. In 1991, Clayman et al. first described a laparoscopic approach to nephroureterectomy (Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM, J Laparoendosc Surg 1(6):343–349, 1991). A laparoscopic approach to upper tract neoplasm has become more prevalent with increasing evidence supporting equivalent oncologic outcomes (Bariol SV, Stewart GD, McNeill SA, Tolley DA, J Urol 172(5):1805–1808, 2004; Muntener M, Nielsen ME, Romero FR, Schaeffer EM, Allaf ME, Brito FA, Pavlovich CP, Kavoussi LR, Jarrett TW, Eur Urol 51:1639–1644, 2007; Capitanio U, Shariat SF, Isbarn H, Weizer A, Remzi M, Roscigno M, Kikuchi E, Raman JD, Bolenz C, Bensalah K, Koppie TM, Kassouf W, Fernandez MI, Strobel P, Wheat J, Zigeuner R, Langner C, Waldert M, Oya M, Guo CC, Ng C, Montorsi F, Wood CG, Margulis V, Karakieweicz PI, Eur Urol 56(1):1–9, 2009; Waldert M, Remzi M, Klinger HC, Mueller L, Marberger M, BJU Int 103(1):66–70, 2009; Berger A, Haber GP, Kamoi K, Aron M, Desai MM, Kauok JH, Gill IS, J Urol 180(3):849–854, 2008; Kawauchi A, Fujito A, Ukimura O, Yoneda K, Mizutani Y, Miki T, J Urol 169(3):890–894, 2003; Stifelman MD, Hyman MJ, Shichman S, Sosa RE, J Endourol 15(4):391–395, 2001; McNeill SA, Chrisofos M, Tolley DA, BJU Int 86(6):619–623, 2000) and a faster convalescence (Stifelman MD, Hyman MJ, Shichman S, Sosa RE, J Endourol 15(4):391–395, 2001; Gill IS, Sung GT, Hobart MG, Savage SJ, Meraney AM, Schweizer DK, Klein EA, Novick AC, J Urol 164(5):1513–1522, 2000; Shalhav AL, Dunn MD, Portis AJ, Elbahnasy AM, McDougall EM, Clayman RV, J Urol 163(4):1100–1104, 2000) as compared to open surgery. More recently, robot-assisted radical nephroureterectomy (RARNU) has been described as an alternative to laparoscopic nephroureterectomy. RARNU offers the potential advantages of improved surgeon efficiency in suturing, ergonomics, and ease of bladder reconstruction after bladder cuff excision without compromise to oncologic efficacy (Park SY, Jeong W, Ham WS, Kim WT, Tha KH, BJU Int 104:June 10(11):1718–1721, 2009; Park SY, Jeong W, Choi YD, Chung BH, Hong SJ, Rha KH, Yonsei Med J 49(6):897–900, 2008; Eun D, Bhandari A, Boris R, Rogers C, Bhandari M, Menon M, BJU Int 100(5):1121–1125, 2007). In this chapter we describe the technique of robot-assisted laparoscopic nephroureterectomy.

Keywords

Intuitive Surgical Distal Ureter Gonadal Vein Ureterovesical Junction Urinary Tract Urothelial Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 11.1 Dilation of the vasal ends (3.20 MB)

Video 11.2 Delivery of suture (2 MB)

Video 11.3 Posterior 9-0 muscularis sutures (5.98 MB)

Video 11.4 Posterior 10-0 mucosal lumen sutures (18 MB)

Video 11.5 Anterior 10-0 mucosal lumen sutures (13.2 MB)

Video 11.6 Anterior 9-0 muscularis sutures (11.3 MB)

Video 11.7 Excision of scar tissue (3 MB)

Video 11.8 Adventitial re-anastomosis (4.92 MB)

Video 11.9 Removal of penrose drain (2.19 MB)

Video 11.10 Incision of epididymal tubule (1.40 MB)

Video 11.11 Posterior 9-0 sutures & 10-0 mucosal anastomosis (10.2 MB)

Video 11.12 Anterior 9-0 sutures (8.77 MB)

Video 11.13 Incision of spermatic cord sheath (4.22 MB)

Video 11.14 Doppler flow identification of testicular artery (1.88 MB)

Video 11.15 Ligation of varicose veins (15.8 MB)

Video 11.16 Closure of spermatic cord sheath (1.96 MB)

Video 11.17 Release of spermatic cord (2.04 MB)

Video 11.18 Incision of the testicular tunica (601 KB)

Video 11.19 Dissection through the testicular lobules (1.16 MB)

Video 11.20 Sampling seminiferous tubules that appear enlarged (2.32 MB)

Video 11.21 Deep lobule sampling if no sperm found readily (710 KB)

Video 11.22 Optional upper or lower testicular pole sampling (0.99 MB)

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Daniel Willis
  • Joseph Pugh
  • Sijo J. Parekattil
  • Hany Atalah
  • Li-Ming Su
    • 1
    Email author
  1. 1.Department of UrologyUniversity of Florida College of MedicineGainesvilleUSA

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