Urology video journal最新文献

{"title":"Vascular challenges in robotic-assisted retroperitoneal lymph node dissection (RA-RPLND)","authors":"Mohammed Almoflihi ,&nbsp;Ahmed Eraky ,&nbsp;Peter Wiklund ,&nbsp;John P. Sfakianos","doi":"10.1016/j.urolvj.2025.100334","DOIUrl":"10.1016/j.urolvj.2025.100334","url":null,"abstract":"<div><h3>Objective</h3><div>To depict approaches on how to handle challenging robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) cases.</div></div><div><h3>Patients and surgical procedure</h3><div>Case 1: 39-year-old male patient with a right testicular mass. The right orchiectomy showed pT2 nonseminomatous germ cell tumors (NSGCTs). Complete staging showed stage IIIC with a retroperitoneal mass, measuring 16×11.4 cm. He completed four cycles of bleomycin (Bleomycin), etoposide (Etoposide), and cisplatin (BEP). On follow-up, tumor markers were normalized, and a CT scan showed an interval decrease in the size of the right retroperitoneal mass measuring 4.0 × 3.2 cm. The patient elected to proceed with RA-RPLND. Case 2: 28-year-old male patient with a history of right testicular mass and incidental Urachal mass. The right orchiectomy showed pT1 NSGCTs. Complete staging showed stage IIB with a retroperitoneal mass measuring 3 × 2 cm. He completed four cycles of BEP. On follow-up, tumor markers were normalized, and a CT scan showed persistent para-aortic mass measuring 3 × 2 cm. The patient was elected to proceed with RA-RPLND and a partial cystectomy. Note: A short clip of an aortic injury showing the layers and concern for proximity to the aorta during RA-RPLND and bleeding control was added at the end of the video.</div></div><div><h3>Results</h3><div>The average console time was 135 min, with an average estimated blood loss of 100 mL. There were no intraoperative and postoperative complications, and the patients were discharged on postoperative day 1.</div></div><div><h3>Conclusion</h3><div>RA-RPLND is a safe and effective treatment for testicular cancer patients in experienced centers.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100334"},"PeriodicalIF":0.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted Excission of prostatic cyst","authors":"Vincenzo Asero ,&nbsp;Giovanni Costa ,&nbsp;Tommaso Silvestri ,&nbsp;Bernardino De Concilio ,&nbsp;Roberto Knez ,&nbsp;Francesco Mastrangelo ,&nbsp;Damiano D'aietti ,&nbsp;Ivan Di Giulio ,&nbsp;Antonio Tumminaro ,&nbsp;Guglielmo Zeccolini ,&nbsp;Antonio Celia","doi":"10.1016/j.urolvj.2025.100337","DOIUrl":"10.1016/j.urolvj.2025.100337","url":null,"abstract":"<div><h3>Background</h3><div>Giant multilocular prostatic cystadenoma is a very rare benign tumor of the prostate gland. It is composed of a fibrous stroma into the pelvis including cystic enlarged prostatic glands. The large size at the time of diagnosis is a consequence of unspecified symptoms which often are linked to common prostatic hyperplasia or irritable bowel syndrome. The diagnosis before histological examination of a surgical specimen is often difficult and based on digital rectal expression, trans-rectal ultra sound (TRUS) and MRI. Here, we present a case involving a largest giant multilocular prostatic cystadenomas and discuss preoperative diagnoses and appropriate surgical approaches for this rare retroperitoneal tumor.</div></div><div><h3>Case presentation</h3><div>A 42 years-old man, with no remote pathological history and no smoking habits, presented multiple episodes of acute urinary retention (AUR), and a pre-catheterization Qmax of 18.4 ml/<em>sec</em> with 243 ml of volume voided followed by an acute episode of septic shock and MOF (anuria, acute renal injury and liver failure) with no symptoms of bowel obstruction. Digital rectal examination was positive for palpable intraluminal mass and sovrapubic ultrasound (US) shown a prostatic abscesses of 65 ml. Serum prostate-specific antigen (PSA) was 4.32 ng/ml at diagnosis. Enhanced CT showed a large retroperitoneal mass measuring 10 × 8 cm in size with multiple septations and displacing the bladder, prostate, and seminal vesicle and MRI showed a cystic mass composed of 9 cm with solid components. Trans-urethral resection of prostate was negative at histological examination for prostate cancer. Complete robot-assisted enucleation of the tumor was performed performing a novel surgical technique. The tumor contained a large cavity with infected material inside and measured 9 × 7 cm. Histologically, the tumor was composed of benign neoformation of prostate consisting of numerous cysts lined by two layers of epithelial cells included in a fibrous and fibromuscular stroma without atypia. Post-operative course was characterized by improvement in terms of LUTS and no changing in erectile function.</div></div><div><h3>Conclusions</h3><div>Our treatment for large giant multilocular prostatic cystadenomas is presented. Robot-assisted surgery for the treatment of GMPC provides another choice for simultaneous attention to disease-control and postoperative quality of life.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100337"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified transperitoneal laparoscopic partial nephrectomy for posterior renal tumor","authors":"José Gaona,&nbsp;Santiago Gaona,&nbsp;Sebastián Ortiz","doi":"10.1016/j.urolvj.2025.100338","DOIUrl":"10.1016/j.urolvj.2025.100338","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe a modified laparoscopic partial nephrectomy combining the advantages of a transperitoneal approach with lumboscopic access for a posterolateral tumor.</div></div><div><h3>Materials and methods</h3><div>A patient with a 28-mm posterolateral left renal tumor underwent surgery. Three anterior transperitoneal trocars were used for mobilization of the bowel and Gerota fascia, dissection of the renal pedicle, and dissection of the retroperitoneal space. Two additional trocars, positioned above the iliac crest and on the posterior axillary line, respectively, were used to gain lumbar access and perform the tumor resection, followed by a two-layer renorrhaphy.</div></div><div><h3>Results</h3><div>The operative time was 150 min, the ischemia time was 17 min, and no complications were reported. The pathological report described a 27-mm clear cell carcinoma with negative surgical margins.</div></div><div><h3>Conclusion</h3><div>Our partial nephrectomy technique offers a straightforward approach to posterolateral tumors, integrating the advantages of both transperitoneal and lumboscopic access.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100338"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical techniques for robotic donor nephrectomy using the single-port robotic platform","authors":"Micah Levy,&nbsp;Chih Peng Chin,&nbsp;Evan B Garden,&nbsp;Daniel Wang,&nbsp;Osama Al-Alao,&nbsp;Francisca Larenas,&nbsp;Michael A Palese","doi":"10.1016/j.urolvj.2025.100336","DOIUrl":"10.1016/j.urolvj.2025.100336","url":null,"abstract":"<div><div>Recent studies have shown comparable outcomes between robotic and laparoscopic donor nephrectomy. Since its FDA approval in 2018, the da Vinci single-port (SP) robotic surgical system has been used for a variety of urologic robotic cases, including more recently, SP robotic donor nephrectomy (SP RDN). We evaluated the outcomes of SP RDN at our institution and discussed the surgical steps and operative considerations when performing SP RDN. 51 donors underwent SP RDN from 9/1/2020 to 7/1/2024 at our institution. Patients were placed in modified flank position and the robotic platform was docked following a 7 cm Pfannenstiel incision and a 12 mm umbilical assistant port placement. Surgical steps included 1) medial reflection of colon and accessing the retroperitoneum, 2) splenic mobilization, 3) exposure of gonadal and renal vein, 4) ligation of adrenal, gonadal, and lumbar vein, 5) dissection of renal hilum, 6) mobilization of upper pole of kidney, 7) lateral and posterior mobilization of kidney, 8) mobilization and ligation of ureter, 9) extraction preparation, 10) ligation of renal artery and vein, 11) kidney extraction. Mean operative, extraction, and warm ischemia times as well as hemoglobin change and length of stay were in line with current literature. Postoperatively, mean donor eGFR ranged was 67.21 mL/min/1.73m² at 2-weeks and 70.1 mL/min/1.73m² at 1-year. Recipient post-op eGFR was 62.9 mL/min/1.73m² by postoperative day 3 and 59.3 mL/min/1.73 m at 1-year. Postoperative 30-day emergency department visit and hospital readmissions were both 1.9 % (1/51). Clavien-Dindo II-IV complications occurred in 9.8 % of patients. Overall, SP RDN is a novel approach to donor nephrectomy, which provides excellent visualization and degrees of freedom that allow surgeons to tackle complex vascular anatomy while reducing number of laparoscopic incisions.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100336"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-port robotic retroperitoneoscopic nephroureterectomy: Technical approach and recommendations for patient selection","authors":"Benjamin Yu,&nbsp;Richard E. Link","doi":"10.1016/j.urolvj.2025.100333","DOIUrl":"10.1016/j.urolvj.2025.100333","url":null,"abstract":"<div><h3>Introduction</h3><div>The Da Vinci single port (SP) robotic system has emerged as a valuable platform for minimally invasive urologic surgery in the past decade. While adoption has been growing rapidly for procedures such as pyeloplasty, partial nephrectomy and radical/simple prostatectomy, its application to retroperitoneal nephroureterectomy has been less thoroughly explored. Here, we describe a retroperitoneoscopic approach to a simple nephroureterectomy using the Da Vinci SP robot and low anterior access. We focus on patient selection, advantages of regionalized SP surgery, and technical tips for operative efficiency and safety.</div></div><div><h3>Patient Case</h3><div>Our patient is a 62-year-old female with recurrent urinary tract infections, chronic right flank pain, severe right hydroureteronephrosis and renal atrophy secondary to a chronically obstructing ureteral stone. Using a low anterior retroperitoneal SP approach, we were able to navigate complex hilar anatomy and perform a simple nephroureterectomy. The patient had no intraoperative complications and an excellent post-operative recovery.</div></div><div><h3>Discussion</h3><div>Proper patient selection is crucial to the success of the retroperitoneal SP approach. The SP system is ideally suited for confined retroperitoneal spaces and smaller specimens, enabling efficient nephroureterectomy through a single incision with reduced patient morbidity. While the SP platform has some limitations, such as fewer available instruments and reduced retraction strength, its advantages in well-selected cases include easier and reproducible access to the renal anatomy, decreased operative time, reduced hospital stays, and improved recovery. This case illustrates the potential for single-port retroperitoneal nephroureterectomy as a minimally invasive alternative to traditional multiport or transperitoneal approaches.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100333"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic assisted anatrophic nephrotomy “oyster-pearl extraction technique” for deep and centrally located endophytic renal mass","authors":"Mahendra Pal ,&nbsp;Amandeep Arora ,&nbsp;Ankit Misra ,&nbsp;Ajit Gujela ,&nbsp;Uday Chandankhede ,&nbsp;Manoj Tummala ,&nbsp;Sugam Godse ,&nbsp;Ganesh Bakshi ,&nbsp;Santosh Menon ,&nbsp;Gagan Prakash","doi":"10.1016/j.urolvj.2025.100332","DOIUrl":"10.1016/j.urolvj.2025.100332","url":null,"abstract":"<div><h3>Introduction &amp; Objectives</h3><div>Endophytic renal tumors pose challenge in achieving the purpose of Nephron sparing surgery (NSS) owing to their lack of visibility over kidney surface. Among these, deep &amp; centrally located variants are notorious as their surgical management involves loss of more nephrons and relatively more compromised vascularity of the spared renal parenchyma. With advent of robotic-assisted interventions, increasing in-depth knowledge on safe ischemia time of kidney, multiple approaches to manage endophytic tumors offer swift post-operative renal recovery. The present video aims to demonstrate the Robotic-assisted ‘Oyster-pearl extraction technique’ via anatrophic nephrotomy in managing deep and centrally located endophytic tumors.</div></div><div><h3>Materials &amp; Methods</h3><div>An elderly female with morbid obesity, presented with a completely endophytic, centrally located left renal mass, size of 25 × 23 × 22 millimeter, with nephrometric score of 10a. On evaluation her Serum creatinine was 0.70 mg/dl, on DTPA scan, GFR of the right and the left kidney was 38 milliliter/minute and 35 milliliter/minute respectively, with no local or distant recurrence. Robotic-assisted ‘Oyster pearl extraction technique’ via anatrophic nephrotomy was performed for excision of the mass.</div></div><div><h3>Result</h3><div>The operating time and warm ischemia time were 165 min and 35 min respectively, with blood loss of 200 ml. The post-operative hospital stay was of 2 days. Histopathology revealed conventional renal cell carcinoma and margins were free of tumor. At 3 months, Serum creatinine was 0.80 mg/dl, GFR of right and left kidney were 35 milliliter/minute and 31 milliliter/minute respectively, with no local or distant recurrence.</div></div><div><h3>Conclusion</h3><div>Robotic-assisted ‘Oyster-pearl extraction technique’ via anatrophic nephrotomy offers a promising approach to manage centrally endophytic renal masses in patients with or without comorbidities with preservation of functional renal parenchyma, swift post-operative recovery along with accepted oncological outcome.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100332"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted laparoscopic neurolysis for pudendal neuralgia occurring after Richter's sacrospinofixation procedure: A 4-steps technique","authors":"Olivier Celhay ,&nbsp;Aurore Maire ,&nbsp;Horace Roman ,&nbsp;Benjamin Merlot","doi":"10.1016/j.urolvj.2025.100330","DOIUrl":"10.1016/j.urolvj.2025.100330","url":null,"abstract":"<div><h3>Introduction</h3><div>Richter's procedure can be responsible for a pudendal neuralgia when the sacrospinofixation device induces a trauma of the pudendal nerve, that roams under the sacrospinous ligament. In case of a direct compression or irritation of the nerve, the patient can experience a neuropathic pain immediately after surgery, needing a surgical revision. Other patients experience a progressive neuropathic pain several months after surgery, due to a postoperative fibrosis secondary to a hematoma. To demonstrate the feasibility of a neurolysis using a robot-assisted laparoscopy for the pudendal neuralgias occurring after Richter's sacrospinofixation technique.</div></div><div><h3>Material and methods</h3><div>Between 2021 and 2024, 6 consecutive patients suffering of a pudendal neuralgia after a Richter's procedure were treated with a robot-assisted laparoscopic neurolysis in our center. We report our technique with a narrated video footage.</div></div><div><h3>Results</h3><div>Robot-assisted laparoscopy for a pudendal neurolysis in 4 steps: Opening of the peritoneum between the external iliac vessels and the umbilical ligament Dissection of the internal iliac and pudendal arteries up to the pudendal nerve Releasing of the pudendal nerve and its branches from the fibrosis Resection of the sacrospinous ligament up to the fixation device The technique was carried out with favorable outcomes.</div><div>1. Opening of the peritoneum between the external iliac vessels and the umbilical ligament</div><div>2. Dissection of the internal iliac and pudendal arteries up to the pudendal nerve</div><div>3. Releasing of the pudendal nerve and its branches from the fibrosis</div><div>4. Resection of the sacrospinous ligament up to the fixation device</div></div><div><h3>Conclusion</h3><div>We demonstrate the feasibility of our technique using a robot-assisted laparoscopy for a complete pudendal neurolysis in case of a neuralgia occurring after Richter's sacrospinofixation.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"26 ","pages":"Article 100330"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial nephrectomy case report: Lower pole segmental vein thrombus","authors":"Brian Calio,&nbsp;Tara Morgan","doi":"10.1016/j.urolvj.2025.100331","DOIUrl":"10.1016/j.urolvj.2025.100331","url":null,"abstract":"<div><div>Here we present a case of a partial nephrectomy of a mass with unanticipated but recognized segmental vein involvement. We were able to safely and completely remove the mass with its vein component and will describe in this video some visual cues and tips for both the surgeon and, importantly, the bedside assistant that can help aid in identification and removal of such tumors while minimizing the risk of leaving cancer behind. In this video we hope to convey the importance of a visual recognition of the tissue plane between the mass and the parenchyma, the need for a coordinated exposure between the surgeon and beside assistant to allow for optimal visualization of the tissue plane; as well as the anticipation for irregular tumor growth and the implementation of appropriate adjustments to minimize positive surgical margins.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100331"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescence guided total robotic parietal peritonectomy, cytoreductive surgery and closed HIPEC","authors":"Somashekhar SP ,&nbsp;Kushal Agrawal ,&nbsp;Rohitkumar C ,&nbsp;Ashwin KR ,&nbsp;Aaron Marian Fernandes ,&nbsp;Nishtha Tripathi ,&nbsp;Srikarthik Voleti ,&nbsp;Medha Sugara ,&nbsp;Vijay Ahuja","doi":"10.1016/j.urolvj.2025.100326","DOIUrl":"10.1016/j.urolvj.2025.100326","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is increasingly used for peritoneal surface malignancies, shifting from open to minimally invasive approaches for lower Peritoneal Carcinomatosis Index(PCI) cases. Robotic surgery's benefits include enhanced visualization, ergonomics, and reduced complications, supporting its adoption in oncologic procedures. We'll outline a step-by-step technique for Fluorescence-Guided Total Robotic Parietal Peritonectomy, Cytoreductive Surgery, and closed HIPEC in advanced peritoneal carcinomatosis.</div></div><div><h3>Patient and Surgical Procedure</h3><div>In this demonstration, we outline the procedure for performing a robotic total parietal peritonectomy with cytoreductive surgery and HIPEC in a 45-year-old patient diagnosed with stage IIIC ovarian cancer and peritoneal carcinomatosis, following three cycles of neoadjuvant chemotherapy (NACT). We highlight the utilization of Indocyanine Green-Near Infrared (ICG-NIR) guided real-time imaging to assess peritoneal deposits post-chemotherapy and guide lymph node dissection.</div></div><div><h3>Results</h3><div>In this case, with a PCI of 15, complete cytoreduction (CC0) was achieved using a minimally invasive robotic approach with HIPEC. The procedure had a short docking time of 22 min and a total console time of 300 min. HIPEC lasted 90 min, and the total operative time, including surgery and HIPEC, was 410 min with minimal blood loss. The patient was discharged on Post operative day 3, showcasing the benefits of this approach in achieving rapid recovery and short hospital stays for peritoneal surface malignancies.</div></div><div><h3>Conclusion</h3><div>Robotic technology like ICG-NIR imaging and advanced tools has boosted the speed and safety of CRS and HIPEC. Success hinges on careful patient selection. The future promises even less invasiveness and better outcomes for peritoneal surface malignancies with minimally invasive and multimodal approaches.</div></div>","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100326"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted laparoscopic right ureterectomy with ileal ureter interposition for upper tract urothelial carcinoma","authors":"Matthew Hudnall,&nbsp;Simone Vernez,&nbsp;Lior Taich,&nbsp;Daniel Lama,&nbsp;Thomas Hwang,&nbsp;Roberto Navarrete,&nbsp;Samer Kirmiz,&nbsp;Humberto Villarreal,&nbsp;Cory Hugen,&nbsp;Clayton Lau","doi":"10.1016/j.urolvj.2025.100328","DOIUrl":"10.1016/j.urolvj.2025.100328","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;In patients with upper tract urothelial carcinoma confined to the proximal or mid ureter, options for kidney preservation are limited without complex ureteral reconstruction. We demonstrate a technique for robotic right ureterectomy with ileal ureter interposition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient and Surgical Procedure&lt;/h3&gt;&lt;div&gt;The patient is a 75-year-old man with bilateral upper tract urothelial carcinoma, in the distal ureter on left and in the proximal-to-mid ureter on right. These were noted to be high grade on endoscopic biopsy. He first underwent uncomplicated robotic left distal ureterectomy with ureteral reimplantation and psoas hitch, with final pathology showing low grade disease. He desired renal preservation, and thus elected for robotic right ureterectomy with ileal ureter interposition to address the right-sided disease.&lt;/div&gt;&lt;div&gt;The patient is placed in flank position with the right side up. The robotic 8 mm ports are placed in the mid-clavicular line, with a 12 mm 4th arm port used to accommodate the robotic stapler. The ureter is dissected free of the surrounding tissue proximally to the renal pelvis and distally to the bladder. Intra-operative ultrasound is used to identify the tumor within the ureteral lumen and mark the proximal margin with a clip. The proximal ureter is then divided. The length of the anticipated ureteral defect is measured with a silk suture. The terminal ileum is marked 15 cm proximal to the ileocecal valve. The measurement suture for the anticipated ureteral defect is then used to mark an appropriate length of ileum, along with a 5 cm ileal discard segment. The robotic stapler is used to divide the planned ileal ureter segment. The bowel anastomosis is completed in a side-to-side fashion with the robotic stapler. The ileal ureteral segment is then anastomosed to the renal pelvis with double-armed 4–0 barbed suture over an 8fr double-J ureteral stent. The robot is then undocked and the patient is repositioned supine with a standard pelvic port configuration. The remainder of the distal ureter is dissected free, and the ureter and bladder cuff are excised. The bladder cuff cystotomy is closed with 3–0 barbed suture. A new cystotomy is made and the distal end of the ileal ureter is anastomosed to the bladder with a double-armed 4–0 barbed suture.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Total operative time was 430 minutes. The patient was discharged on post-operative day two. The ureteral stent was removed after 6 weeks. Final pathology demonstrated a 2 cm segment of low grade non-invasive urothelial carcinoma with focal high-grade areas and negative margins. A 3-month follow up CT scan showed no evidence of disease. Mild right hydronephrosis was present. The patient's renal function was normal.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In appropriately selected patients with upper tract urothelial carcinoma of the proximal or mid ureter, robotic ureteral excision with ileal ureter recons","PeriodicalId":92972,"journal":{"name":"Urology video journal","volume":"25 ","pages":"Article 100328"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}