Presented by: Taketoshi Nara MD
Department of Urology, Akita University Graduate School of Medicine

Introduction

Patients presenting with invasive bladder cancer and concurrent upper urinary tract malignancy must prefer simultaneous nephroureterectomy (NU) and radical cystectomy. However, few reports of robotic-assisted radical cystectomy (RARC) and laparoscopic or robotic NU performed in a single stage have been available. We report 4 cases of simultaneous RARC and laparoscopic or robotic NU.

Materials

We performed 4 cases of simultaneous laparoscopic unilateral NU (3 laparoscopic, one robotic) and RARC at our hospital between 2019 and 2022. Clinical factors and preoperative and postoperative parameters were retrospectively analyzed.

Results

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The median age of the four patients was 66.5 years（range 45-75）, two males and two females. The median operative time was 664 minutes (range 576-845 minutes), and estimated blood loss was 412 ml (range311-1910 ml). The intracorporeal technique of urinary diversion was applied for all four cases. According to the Clavien-Dindo Classification system, Grade IIIA of wound dehiscence occurred in one patient. The patient's position was changed from lateral to supine after finishing NU. Eight or nine ports were used in each NU＋RARC. At the RARC part, three or four NU ports were shared as RARC ports.

Conclusion

By positioning the trocar placement, the number of trocars used in laparoscopic or robotic NU and RARC could be reduced, allowing for a minimally invasive procedure. Simultaneous laparoscopic or robotic NU and RARC should be feasible and safe surgical options.

Funding

The authors have no conflicts of interest directly relevant to the content of this article.

Lead Authors

Kazuyuki Numakura, MD,PHD
Department of Urology, Akita University Graduate School of Medicine

Ryuichiro Sagehashi, MD
Department of Urology, Akita University Graduate School of Medicine

Mizuki Kobayashi, MD,PHD
Department of Urology, Akita University Graduate School of Medicine

Ryohei Yamamoto, MD,PHD
Department of Urology, Akita University Graduate School of Medicine

Saito Mitsuru, MD,PHD
Department of Urology, Akita University Graduate School of Medicine

Shintaro Narita, MD,PHD
Department of Urology, Akita University Graduate School of Medicine

Tomonori Habuchi, MD,PHD
Department of Urology, Akita University Graduate School of Medicine