機械手臂輔助後腹腔全腔內手術治療上泌尿道尿路上皮癌之初步經驗分享

謝佳駤¹、曾文歆^1,2、劉建良^1,3、黃冠華¹

¹台南永康奇美醫院 外科部 泌尿科；²高雄國立中山大學 生物醫學研究所；³台南永康奇美醫院 外科部 泌尿腫瘤科

Initial Experience Sharing with Robotic-Assisted Retroperitoneal Total Intracorporeal Approach for Upper Urinary Tract Urothelial Carcinoma

Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Chien-Liang Liu ^1,3、Steven K. Huang¹

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.

Purpose: Ureteral and renal pelvic urothelial carcinomas comprise 5–10% of UC in developed nations. Taiwan shows one of the highest global upper tract urothelial cancer (UTUC) incidences, particularly in women. Radical nephroureterectomy with bladder cuff excision (RNU-BCE) is standard surgical treatment. Laparoscopic radical nephroureterectomy with open method for bladder cuff excision is the most commonly performed technique at our medical center for more than ten years. We share our institution’s initial experience with retroperitoneal robotic intracorporeal RNU-BCE for UTUC since 2024.

Materials and Methods: We retrospectively reviewed 12 patients with UTUC treated between January 2024 and January 2025 at our medical center. All underwent robotic-assisted laparoscopic retroperitoneal total intracorporeal RNU-BCE using the Da Vinci Xi system with a four-arm configuration. All trocars were inserted into the retroperitoneal space. The patient cart was first docked laterally, targeting the kidney and upper ureter, then undocked to rotate the boom for access to the lower ureter and bladder cuff. Lower ureterectomy and bladder cuff excision were performed sequentially. Perioperative and pathological outcomes were analyzed.

Results: Among the 12 patients, 5 (41.7%) had right-sided and 7 (58.3%) left-sided tumors, with a mean age of 69.5 ± 6.1 years. Mean console time was 160 ± 36 minutes, and bladder cuff excision averaged 66.5 ± 31.5 minutes. Surgical margins were negative in all cases. With a mean follow-up of 9.2 ± 2.2 months, no bladder recurrence or Clavien-Dindo grade ≥3 complications occurred. Our initial experience revealed several technical challenges that need to be addressed. First, limited maneuverability of the robotic arms within the restricted retroperitoneal working space. Second, the reduced flexibility for the assistant during bladder cuff excision due to the anatomical constraint imposed by the psoas muscle.

Conclusion: This case series presents our initial experience with robotic-assisted laparoscopic retroperitoneal total intracorporeal RNU-BCE for UTUC. Previous studies suggest that total intracorporeal techniques are non-inferior to open surgery, offering less postoperative pain and comparable oncological outcomes. A larger surgical volume is likely required to optimize and maintain clinical outcomes.