吳振宇¹，陳毓騏¹，陳忠賢¹，林嘉祥^{1, 2}

義大醫院 泌尿科1

義守大學 學士後醫學系外國學生專班2

Richard C. Wu¹, Yu-Chi Chen¹, Chung-Hsien Chen¹, Victor C. Lin^{1, 2}

1. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan;

2. School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan

 

 

Purpose: The gold standard to treat upper tract urothelial carcinoma (UC) is nephroureterectomy with bladder cuff excision. However, the kidney sparing strategy has been brought out and need more evidence to prove the benefit. Segmental resection with different reconstruction strategies is a feasible way to treat UC of ureter. However, the reconstruction need complex procedures and may cause more operating time. Moreover, use intestine for replacement may lead to bowel complications. This article is aim to provide our peri-operative outcome of robotic assisted laparoscopic segmental ureterectomy with ureteroureterostomy.

Materials and Methods: We provide patient who was diagnosed with UC of ureter with single lesion and the metastatic disease was ruled out. There were 6 patients, two had chronic kidney disease and one had solitary kidney, underwent robotic assisted segmental resection of ureter with primary anastomosis between June 2016 to February 2017. We collected the basic demographics, renal function, and peri-operative parameters retrospectively. Cross image was necessary for evaluation of resected site and was obtained in all of the patients. All operation was carried out with trans-peritoneal rout with lateral decubitus surgical position and four robotic ports with one assistant port was setup differently according to varied tumor site. Ureteral stent was placed routinely and the indwelling time was depending on intra-operative finding including resection length, tissue condition and the tension of the anastomosis.

Results: The perioperative outcomes included a mean console time of 212 minutes (100 – 390), total blood loss of 48 ml (10 – 100), 7 days (4 – 10) postoperative hospitalization and ureteral stent catheterization time of 56 days (27 – 132). No patient was converted to open surgery. Mean total specimen length, including cutend specimens obtained for frozen pathology, was 5.1 cm (3.8 – 6.5) and the surgical margin free rate was 100%. The eGFR change between pre-operative and one week after ureteral stent retrieval was 0.5 mL/min/1.73m² (-3 – 5). All of the patients has smooth in-patient course without high grade complication. There was only one patient developed postoperative ureteral stricture and the resection length of ureter was 4 cm.

Conclusion: Technically speaking, robotic assisted laparoscopic segmental resection with ureteroureterostomy is a feasible operation to treat UC of ureter. However, we need longer follow-up to report the oncologic outcome and reduce the postoperative hydronephrosis rate.