Single-Port Robotic-Assisted Laparoscopic Right Nephroureterectomy
Angela Estevez, MD, Utsav Bansal, MD, Philip Kim, MD, Andrew A Wagner, MD, Peter Chang, MD, MPH
Beth Israel Deaconess Medical Center, Boston, MA, USA
Introduction: We present the case of a 73 year-old female with a history of gross hematuria. CT scan showed a right ureteral lesion and severe right hydroureteronephrosis with cortical thinning. She was taken for ureteroscopy and biopsy, which showed a papillary tumor. Pathology was inconclusive and cytology was suspicious for malignancy. In the context of a presumptive diagnosis of upper tract urothelial carcinoma and chronically obstructed kidney, we recommended to proceed with robotic-assisted laparoscopic right nephroureterectomy. Methods: The patient was placed in a right side up modified lateral decubitus position. We made a 3 cm incision on the right side lateral to the umbilicus. Lateral to the previous incision, we placed a 12 mm Airseal and superiorly, we placed a 5 mm port for the liver retractor. We initiated the procedure by mobilizing both the right colon medially and the lower pole of the kidney anteriorly off the psoas muscle. We then divided the right renal hilar vessels, followed by right upper pole mobilization. After the lateral attachments were transected, we circumferentially dissected the ureter from surrounding tissue to the level of the ureteral orifice. We then closed the bladder defect in two layers using 3-0 V-loc suture. Results: The operative time was 268 minutes with an estimated blood loss of 50 cc. There were no intraoperative complications. The patient tolerated the procedure well, the hospital course was unremarkable, and the patient was discharged on post-operative day 3. The patient was seen in follow-up four weeks after surgery and has been recovering well. Final pathology showed high grade T1 upper tract urothelial carcinoma in the right ureter with negative margins.Conclusion: Single-port robotic assisted laparoscopic right nephroureterectomy is a feasible and well tolerated procedure for the management of upper tract urothelial carcinoma.
Back to 2023 Abstracts