Introduction of robot assisted nephro-ureterectomy: The potential for improved initial perioperative outcomes over a conventional laparoscopic approach
BAUS ePoster online library. Hughes-Hallett A. Jun 27, 2018; 211380
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Archie Hughes-Hallett
Archie Hughes-Hallett
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Abstract
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Introduction: Robot assisted nephroureterectomy (RNU) for the management of upper tract urothelial carcinoma may be used as an alternative minimally invasive approach to laparoscopic nephroureterectomy (LNU). We asked whether introduction of RNU was associated with improved perioperative outcomes when compared to LNU at our high-volume kidney cancer centre.

Methods: Perioperative outcome data from a longitudinal cohort of RNU and LNU performed at a single institution over a 22 month period (Aug '16 - Oct '17) was retrospectively analysed. RNU was introduced to our service on acquisition of a Da Vinci Xi Surgical System midway through the study period. In this period both LNU and RNU were performed according to surgeon preference.

Results: 51 patients underwent RNU, and 34 LNU. As can be seen in Table 1 the RNU cohort had a significantly shorter length of catheterisation, days to mitomycin C, and length of stay. In addition, there was a reduction in the use of post-operative cystograms, radiological bladder leak and post-operative haemoglobin drop.

Conclusions: This retrospective study shows improved peri-operative outcomes for RNU over LNU in this cohort. With a reduction in bladder leak, need for cystogram, length of post-operative catheterization, and LOS in the RNU group. In addition, the procedure allows for closer recapitulation of open surgical principles for the distal ureter, with primary bladder closure and leak test achieved in 98% patients in the RNU cohort.
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