Robot-Assisted Laparoscopic Surgery for Upper Tract Urothelial Carcinoma

  • Sung Yul ParkEmail author
  • Young Eun Yoon


When initially robot-assisted laparoscopic surgery was introduced in urologic field, the focus was on radical prostatectomy and partial nephrectomy. It was quite true that upper tract urothelial carcinoma (UTUC), which had no major problem with laparoscopic operations, was late in the introduction of robotic surgery. One of the reasons for the late introduction of the robot for UTUC was difficulty in port placement due to relatively wide operation field. However, through various port arrangement modification, lots of UTUCs are treated with robot-assisted laparoscopic surgeries.

This chapter focuses on nephroureterectomy, the gold standard of UTUC treatment. We will discuss the preparation of robot-assisted laparoscopic nephroureterectomy, perioperative and oncologic outcome, and lymph node dissection, and will look into robotic LESS nephroureterectomy, which is a more advanced and less invasive than conventional robot surgery. We also look into what kind of robot-assisted laparoscopic surgery could be performed instead of nephroureterectomy when nephron saving procedure is needed.


Urothelial cancer Robot-assisted surgery Nephroureterectomy Urinary tract 


  1. Aboumohamed AA, Krane LS, Hemal AK. Oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma. J Urol. 2015;194(6):1561–6.PubMedGoogle Scholar
  2. Alvarez-Maestro M, Rivas JG, Gregorio SA, Guerin CC, Gomez AT, Ledo JC. Current role of lymphadenectomy in the upper tract urothelial carcinoma. Cent Eur J Urol. 2016;69(4):384–90.Google Scholar
  3. Ambani SN, Weizer AZ, Wolf JS Jr, He C, Miller DC, Montgomery JS. Matched comparison of robotic vs laparoscopic nephroureterectomy: an initial experience. Urology. 2014;83(2):345–9.PubMedGoogle Scholar
  4. Argun OB, Mourmouris P, Tufek I, Tuna MB, Keskin S, Obek C, et al. Radical nephroureterectomy without patient or port repositioning using the da Vinci Xi robotic system: initial experience. Urology. 2016;92:136–9.PubMedGoogle Scholar
  5. Azawi NH, Berg KD, Thamsborg AKM, Dahl C, Jepsen JV, Kroman-Andersen B, et al. Laparoscopic and robotic nephroureterectomy: does lymphadenectomy have an impact on the clinical outcome? Int Urol Nephrol. 2017;49:1785–92.PubMedGoogle Scholar
  6. Badani KK, Rothberg MB, Bergman A, Silva MV, Shapiro EY, Nieder A, et al. Robot-assisted nephroureterectomy and bladder cuff excision without patient or robot repositioning: description of modified port placement and technique. J Laparoendosc Adv Surg Tech A. 2014;24(9):647–50.PubMedGoogle Scholar
  7. Borghesi M, Brunocilla E, Schiavina R, Martorana G. Robot-assisted radical nephroureterectomy for upper urinary tract urothelial carcinoma: a promising alternative to open surgery or a future “gold standard”? Clin Genitourin Cancer. 2014;12(2):e65–6.PubMedGoogle Scholar
  8. Catto JW, Yates DR, Rehman I, Azzouzi AR, Patterson J, Sibony M, et al. Behavior of urothelial carcinoma with respect to anatomical location. J Urol. 2007;177(5):1715–20.PubMedGoogle Scholar
  9. Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, et al. Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: results from a large French multicentre study. BJU Int. 2012;110(8):1134–41.PubMedGoogle Scholar
  10. Darwiche F, Swain S, Kallingal G, Punnen S, Manoharan M, Parekh DJ, et al. Operative technique and early experience for robotic-assisted laparoscopic nephroureterectomy (RALNU) using da Vinci Xi. Springerplus. 2015;4:298.PubMedPubMedCentralGoogle Scholar
  11. Eandi JA, Nelson RA, Wilson TG, Josephson DY. Oncologic outcomes for complete robot-assisted laparoscopic management of upper-tract transitional cell carcinoma. J Endourol. 2010;24(6):969–75.PubMedGoogle Scholar
  12. Eun D, Bhandari A, Boris R, Rogers C, Bhandari M, Menon M. Concurrent upper and lower urinary tract robotic surgery: strategies for success. BJU Int. 2007;100(5):1121–5.PubMedGoogle Scholar
  13. Glinianski M, Guru KA, Zimmerman G, Mohler J, Kim HL. Robot-assisted ureterectomy and ureteral reconstruction for urothelial carcinoma. J Endourol. 2009;23(1):97–100.PubMedGoogle Scholar
  14. Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998;52(4):594–601.PubMedGoogle Scholar
  15. Hemal AK, Stansel I, Babbar P, Patel M. Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology. 2011;78(2):357–64.PubMedGoogle Scholar
  16. Hu JC, Silletti JP, Williams SB. Initial experience with robot-assisted minimally-invasive nephroureterectomy. J Endourol. 2008;22(4):699–704.PubMedGoogle Scholar
  17. Hu CY, Yang CK, Huang CY, Ou YC, Hung SF, Chung SD, et al. Robot-assisted laparoscopic nephroureterectomy versus hand-assisted laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a matched comparison study. Biomed Res Int. 2015;2015:918486.PubMedPubMedCentralGoogle Scholar
  18. Jeldres C, Lughezzani G, Sun M, Isbarn H, Shariat SF, Budaus L, et al. Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol. 2010;183(4):1324–9.PubMedGoogle Scholar
  19. Kaouk JH, Goel RK, Haber GP, Crouzet S, Stein RJ. Robotic single-port transumbilical surgery in humans: initial report. BJU Int. 2009;103(3):366–9.PubMedGoogle Scholar
  20. Khanna R, Stein RJ, White MA, Isac W, Laydner H, Autorino R, et al. Single institution experience with robot-assisted laparoendoscopic single-site renal procedures. J Endourol. 2012;26(3):230–4.PubMedGoogle Scholar
  21. Kondo T, Hashimoto Y, Kobayashi H, Iizuka J, Nakazawa H, Ito F, et al. Template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract: impact on patient survival. Int J Urol. 2010;17(10):848–54.PubMedGoogle Scholar
  22. Kondo T, Hara I, Takagi T, Kodama Y, Hashimoto Y, Kobayashi H, et al. Possible role of template-based lymphadenectomy in reducing the risk of regional node recurrence after nephroureterectomy in patients with renal pelvic cancer. Jpn J Clin Oncol. 2014;44(12):1233–8.PubMedGoogle Scholar
  23. Lee Z, Llukani E, Reilly CE, Mydlo JH, Lee DI, Eun DD. Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults. J Endourol. 2013;27(8):994–9.PubMedGoogle Scholar
  24. Lim SK, Shin TY, Kim KH, Chung BH, Hong SJ, Choi YD, et al. Intermediate-term outcomes of robot-assisted laparoscopic nephroureterectomy in upper urinary tract urothelial carcinoma. Clin Genitourin Cancer. 2013;11(4):515–21.PubMedGoogle Scholar
  25. Lim SK, Shin TY, Kim KH, Han WK, Chung BH, Hong SJ, et al. Laparoendoscopic single-site (LESS) robot-assisted nephroureterectomy: comparison with conventional multiport technique in the management of upper urinary tract urothelial carcinoma. BJU Int. 2014;114(1):90–7.PubMedGoogle Scholar
  26. Lughezzani G, Jeldres C, Isbarn H, Sun M, Shariat SF, Alasker A, et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer. 2009;45(18):3291–7.PubMedGoogle Scholar
  27. Lughezzani G, Jeldres C, Isbarn H, Shariat SF, Sun M, Pharand D, et al. A critical appraisal of the value of lymph node dissection at nephroureterectomy for upper tract urothelial carcinoma. Urology. 2010;75(1):118–24.PubMedGoogle Scholar
  28. Marshall S, Stifelman M. Robot-assisted surgery for the treatment of upper urinary tract urothelial carcinoma. Urol Clin North Am. 2014;41(4):521–37.PubMedGoogle Scholar
  29. McClain PD, Mufarrij PW, Hemal AK. Robot-assisted reconstructive surgery for ureteral malignancy: analysis of efficacy and oncologic outcomes. J Endourol. 2012;26(12):1614–7.PubMedGoogle Scholar
  30. Melquist JJ, Redrow G, Delacroix S, Park A, Faria EE, Karam JA, et al. Comparison of single-docking robotic-assisted and traditional laparoscopy for retroperitoneal lymph node dissection during nephroureterectomy with bladder cuff excision for upper-tract urothelial carcinoma. Urology. 2016;87:216–23.PubMedGoogle Scholar
  31. Moussa S, Yafi FA, El-Hakim A, Fahmy N, Aprikian A, Tanguay S, et al. Outcome of surgical treatment of patients with upper versus lower urinary tract urothelial carcinoma: stage-by-stage comparison. Urol Int. 2010;84(1):50–5.PubMedGoogle Scholar
  32. Nanigian DK, Smith W, Ellison LM. Robot-assisted laparoscopic nephroureterectomy. J Endourol. 2006;20(7):463–5; discussion 5–6.PubMedGoogle Scholar
  33. Ozdemir AT, Altinova S, Asil E, Balbay MD. Robotic-assisted laparoscopic nephroureterectomy and bladder cuff excision. J Soc Laparoendosc Surgeons. 2012;16(2):320–4.Google Scholar
  34. Park SY, Jeong W, Choi YD, Chung BH, Hong SJ, Rha KH. Yonsei experience in robotic urologic surgery-application in various urological procedures. Yonsei Med J. 2008;49(6):897–900.PubMedPubMedCentralGoogle Scholar
  35. Park SY, Jeong W, Ham WS, Kim WT, Rha KH. Initial experience of robotic nephroureterectomy: a hybrid-port technique. BJU Int. 2009;104(11):1718–21.PubMedGoogle Scholar
  36. Patel MN, Aboumohamed A, Hemal A. Does transition from the da Vinci Si to Xi robotic platform impact single-docking technique for robot-assisted laparoscopic nephroureterectomy? BJU Int. 2015;116(6):990–4.PubMedGoogle Scholar
  37. Pugh J, Parekattil S, Willis D, Stifelman M, Hemal A, Su LM. Perioperative outcomes of robot-assisted nephroureterectomy for upper urinary tract urothelial carcinoma: a multi-institutional series. BJU Int. 2013;112(4):E295–300.PubMedGoogle Scholar
  38. Raheem AA, Alatawi A, Kim DK, Sheikh A, Rha KH. Feasibility of Robot-assisted segmental ureterectomy and ureteroureterostomy in patient with high medical comorbidity. Int Braz J Urol. 2017;43(4):779–80.PubMedPubMedCentralGoogle Scholar
  39. Rao SR, Correa JJ, Sexton WJ, Pow-Sang JM, Dickinson SI, Lin HY, et al. Prospective clinical trial of the feasibility and safety of modified retroperitoneal lymph node dissection at time of nephroureterectomy for upper tract urothelial carcinoma. BJU Int. 2012;110(11 Pt B):E475–80.PubMedGoogle Scholar
  40. Rose K, Khan S, Godbole H, Olsburgh J, Dasgupta P. Robotic assisted retroperitoneoscopic nephroureterectomy—first experience and the hybrid port technique. Int J Clin Pract. 2006;60(1):12–4.PubMedGoogle Scholar
  41. Schimpf MO, Wagner JR. Robot-assisted laparoscopic Boari flap ureteral reimplantation. J Endourol. 2008;22(12):2691–4.PubMedGoogle Scholar
  42. Schimpf MO, Wagner JR. Robot-assisted laparoscopic distal ureteral surgery. J Soc Laparoendosc Surgeons. 2009;13(1):44–9.Google Scholar
  43. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.PubMedGoogle Scholar
  44. Simonato A, Varca V, Gregori A, Benelli A, Ennas M, Lissiani A, et al. Elective segmental ureterectomy for transitional cell carcinoma of the ureter: long-term follow-up in a series of 73 patients. BJU Int. 2012;110(11 Pt B):E744–9.PubMedGoogle Scholar
  45. Trudeau V, Gandaglia G, Shiffmann J, Popa I, Shariat SF, Montorsi F, et al. Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: a population-based assessment of costs and perioperative outcomes. Canadian Urol Assoc J. 2014;8(9–10):E695–701.Google Scholar
  46. Uberoi J, Harnisch B, Sethi AS, Babayan RK, Wang DS. Robot-assisted laparoscopic distal ureterectomy and ureteral reimplantation with psoas hitch. J Endourol. 2007;21(4):368–73; discussion 72–3.PubMedGoogle Scholar
  47. Uffort EE, Jensen JC. Two-year outcomes after robotic renal surgery: a single surgeon’s experience. J Robot Surg. 2010;4(4):205–10.PubMedGoogle Scholar
  48. White WM, Haber G-P, Goel RK, Crouzet S, Stein RJ, Kaouk JH. Single-port urological surgery: single-center experience with the first 100 cases. Urology. 2009;74(4):801–4.PubMedGoogle Scholar
  49. Won Lee J, Arkoncel FR, Rha KH, Choi KH, Yu HS, Chae Y, et al. Urologic robot-assisted laparoendoscopic single-site surgery using a homemade single-port device: a single-center experience of 68 cases. J Endourol. 2011;25(9):1481–5.PubMedGoogle Scholar
  50. Yang C, Jones L, Rivera ME, Verlee GT, Deane LA. Robotic-assisted ureteral reimplantation with Boari flap and psoas hitch: a single-institution experience. J Laparoendosc Adv Surg Tech A. 2011;21(9):829–33.PubMedGoogle Scholar
  51. Yang CK, Chung SD, Hung SF, Wu WC, Ou YC, Huang CY, et al. Robot-assisted nephroureterectomy for upper tract urothelial carcinoma: the Taiwan Robot Urological Surgery Team (TRUST) experience. World J Surg Oncol. 2014;12:219.PubMedPubMedCentralGoogle Scholar
  52. Zargar H, Krishnan J, Autorino R, Akca O, Brandao LF, Laydner H, et al. Robotic nephroureterectomy: a simplified approach requiring no patient repositioning or robot redocking. Eur Urol. 2014;66(4):769–77.PubMedGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of UrologyHanyang University College of MedicineSeoulSouth Korea

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