Robot-assisted ureterectomy and ureteral reconstruction for urothelial carcinoma

Background and Purpose: Urothelial carcinoma of the distal ureter can be managed by ureterectomy followed by reconstruction of the urinary system. We review our experience with robot-assisted ureterectomy. Patients and Methods: Nine consecutive patients who were candidates for ureterectomy underwent robot-assisted surgery between 7/8/2005 and 7/25/2006. Patient characteristics, intraoperative parameters, and short-term outcomes were retrospectively reviewed. Results: Mean operative time was 252 minutes. The mean blood loss was 44 mL, and no patient needed a transfusion. The mean hospital stay was 1.5 days. Six patients needed a psoas hitch; one patient each underwent a primary ureteral anastomosis, a direct ureteral reimplant into the dome of the bladder, and distal ureterectomy for tumor in a ureteral stump after nephrectomy. The ureteral reimplant was performed intravesically in one patient and extravesically in five patients. A bladder cuff was excised in all patients who were undergoing a distal ureterectomy. All surgical margins were negative, and five patients had high-grade tumor. A ureteral stricture developed in one patient, and a patient experienced aspiration pneumonia in the postoperative period. Conclusions: Robot-assisted ureterectomy and ureteral reconstruction is safe and feasible, and offers patients the advantages of minimally invasive surgery. Future studies with additional patients and longer follow-up will determine the oncologic effectiveness of this procedure.