Current Status of Robot Assisted Laparoscopic Radical Nephroureterectomy for Management of Upper Tract Urothelial Carcin
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MINIMALLY INVASIVE SURGERY (V BIRD, SECTION EDITOR)
Current Status of Robot Assisted Laparoscopic Radical Nephroureterectomy for Management of Upper Tract Urothelial Carcinoma Sey Kiat Lim & Tae-Young Shin & Koon Ho Rha
Published online: 11 January 2013 # Springer Science+Business Media New York 2013
Abstract Upper tract urothelial carcinomas (UUT-UC) are usually aggressive tumours and require radical treatments. The standard of care for localised UUT-UC is radical nephroureterectomy (RNU). Robot-assisted laparoscopic surgeries are currently employed in various urological procedures, including RNU. We conducted a literature search on medical databases (PubMed/ MEDLINE) using free text keywords nephroureterectomy, distal ureter, bladder cuff, urothelial carcinoma and/or robotic. In this review, we aim to provide an up-to-date status on robot-assisted laparoscopic nephroureterectomy (RAL-NU) for the management of UUT-UC. The various surgical techniques and approaches for RAL-NU and retroperitoneal lymph node dissection (RPLND) will be discussed and their perioperative and early oncological outcomes reported. The feasibility and safety of RAL-NU has been demonstrated in a number of studies but intermediate and long term clinical and oncological outcomes are still lacking. Keywords Robot . Laparoscopy . Urothelial carcinoma . Upper tract . Nephroureterectomy . Distal ureter . Bladder cuff . Surgery . Techniques . Oncological outcomes. S. K. Lim : T.-Y. Shin : K. H. Rha (*) Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea e-mail: [email protected] S. K. Lim e-mail: [email protected] T.-Y. Shin e-mail: [email protected]
Introduction Although upper urinary tract urothelial carcinoma (UUTUC) accounts for only 5 % of all urothelial malignancy, these are usually aggressive tumours and require radical treatments. The standard of care for localised UUT-UC is radical nephroureterectomy (RNU) which entails the enbloc excision of the kidney, ipsilateral ureter and a cuff of the bladder including the ipsilateral ureteric orifice. Despite such radical treatment, the Upper Tract Urothelial Carcinoma Collaboration group reported the 5 year cancer specific survival after RNU as only 73 % [1••]. In this era of minimally invasive surgery, the gold standard for RNU is still the open approach. Since Clayman et al. reported the first successful laparoscopic nephroureterectomy (LNU) in 1991 [2], LNU has emerged as a feasible and effective alternative to the open approach over the last two decades. LNU offers the additional benefit of smaller incision wounds, lower narcotics usage, shorter length of hospitalization and reduced convalescent time [3]. However, despite these advantages, LNU remained an approach that is difficult to master due to the 2-dimensional intracorporeal visualisation, limited tactile feedback, restricted ergonomics of laparoscopic instruments and limited working space in the pelvis. The introduction of the daVinci robotic s
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