https://doi.org/10.4081/aiua.2021.1.101

Robot-assisted segmental ureterectomy with psoas hitch ureteral reimplantation: Oncological, functional and perioperative outcomes of case series of a single centre

Vol. 93 No. 1 (2021)
Published: March 22, 2021
Robotics; Segmental ureterectomy; Ureter; Urothelial carcinoma; Psoas hitch reimplantation
Abstract Views: 1136
PDF: 585
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Erika Palagonia
erika.palagonia@gmail.com
Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
Simone Scarcella
Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
Lucio Dell'Atti
Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
Giulio Milanese
Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
Peter Schatteman
ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
Frederiek D'Hondt
ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
Geert De Naeyer
ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.
Andrea B. Galosi
Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy.
Alexander Mottrie
ORSI Academy, Melle; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst, Belgium.

Introduction: According to the Urology guidelines, in selected cases of distal upper tract urothelial carcinoma (UTUC) segmental ureterectomy (SU) can be offered. There is no consensus in the surgical technique of preference. Robot-assisted SU could be an option to overcome all the limitations of open and laparoscopic techniques. We describe our first experience of robot assisted SU with psoas hitch ureteral reimplantation (RAPHUR).
Materials and methods: 11 patients underwent RAPHUR for distal UTUC between 2013 and 2017 in a single centre. Pre-, intra-, and postoperative outcomes were assessed. Conventional imaging was performed after 1, 3, 6 months and 1 year from surgery as follow up protocol. We retrospectively evaluated the technical feasibility, oncological and functional outcomes.
Results: Median age was 71 years (57-91). The median length of the ureteral defect was 23 mm (10-40). Median preoperative creatinine level was 1.22 mg/dl (0.7-1.85) and median eGFR was 57.5 ml/min/1.73m2 (31-80). Five (45.5%) patients were symptomatic and 7 (63.6%) had hydronephrosis. Median operative time was 185 min (120-240), with a median blood loss of 100 ml (50-300). No case required conversion to open surgery. Overall, only 1 (9%) patient developed Clavien Dindo ≥ 3 postoperative complications. Average hospital stay was 7 (2-9) days. Mean postoperative creatinine was 1.05 mg/dl (0.8-1.85) and mean postoperative eGFR was 72 (36-83). During a median follow up time of 25.5 months (12-53), 4 (36.4%) patients experienced recurrence of urothelial cancer at conventional imaging follow up and 2 (18.2%) died due to its progression.
Conclusions: In our initial experience RAPHUR can be proposed to selected cases of distal ureteral carcinoma with optimal perioperative and functional outcomes. However, cancer control may be undermined compared to nephroureterectomy. Thus, further prospective studies are needed to confirm our findings.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: A series from the upper tract urothelial carcinoma collaboration. Cancer. 2009;115:1224–33. DOI: https://doi.org/10.1002/cncr.24135
Lughezzani G, Jeldres C, Isbarn H, Sun M, Shariat SF, Alasker A, et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: A population-based study of 2299 patients. Eur J Cancer. 2009;45:3291–7. DOI: https://doi.org/10.1016/j.ejca.2009.06.016
Colin P, Ouzzane A, Pignot G, Ravier E, Crouzet S, Ariane MM, et al. Comparison of oncological outcomes after segmental ureterectomy or radical nephroureterectomy in urothelial carcinomas of the upper urinary tract: Results from a large French multicentre study. BJU Int. 2012;110:1134–41. DOI: https://doi.org/10.1111/j.1464-410X.2012.10960.x
Jeldres C, Lughezzani G, Sun M, Isbarn H, Shariat SF, Budaus L, et al. Segmental ureterectomy can safely be performed in patients with transitional cell carcinoma of the ureter. J Urol. 2010 Apr;183:1324–9. DOI: https://doi.org/10.1016/j.juro.2009.12.018
Uberoi J, Harnisch B, Sethi AS, Babayan RK, Wang DS. Robot-assisted laparoscopic distal ureterectomy and ureteral reimplantation with psoas hitch. J Endourol. 2007;21:368–72. DOI: https://doi.org/10.1089/end.2007.9970
Hemal AK, Nayyar R, Gupta NP, Dorairajan LN. Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies. Urology. 2010 ;76:1387–93. DOI: https://doi.org/10.1016/j.urology.2010.01.044
Fifer GL, Raynor MC, Selph P, Woods ME, Wallen EM, Viprakasit DP, et al. Robotic ureteral reconstruction distal to the ureteropelvic junction: a large single institution clinical series with short-term follow up. J Endourol. 2014;28:1424–8. DOI: https://doi.org/10.1089/end.2014.0227
Elsamra SE, Theckumparampil N, Garden B, Alom M, Waingankar N, Leavitt DA, et al. for Benign and Malignant Ureteral Lesions : A Comparison of Over 100 Minimally Invasive Cases. 2014;28:1455–9. DOI: https://doi.org/10.1089/end.2014.0243
Campi R, Cotte J, Sessa F, Seisen T, Tellini R, Amparore D, et al. Robotic radical nephroureterectomy and segmental ureterectomy for upper tract urothelial carcinoma: a multi-institutional experience. World J Urol. 2019;37:2303–11. DOI: https://doi.org/10.1007/s00345-019-02790-y
McClain PD, Mufarrij PW, Hemal AK. Robot-assisted reconstructive surgery for ureteral malignancy: Analysis of efficacy and oncologic outcomes. J Endourol. 2012;26:1614–7. DOI: https://doi.org/10.1089/end.2012.0219
Schimpf MO, Wagner JR. Robot-assisted laparoscopic distal ureteral surgery. JSLS J Soc Laparoendosc Surg. 2009;13:44–9.
Musch M, Hohenhorst L, Pailliart A, Loewen H, Davoudi Y, Kroepfl D. Robot-assisted reconstructive surgery of the distal ureter : single institution experience in 16 patients. 2013;773–83. DOI: https://doi.org/10.1111/j.1464-410X.2012.11673.x
Mitropoulos D, Artibani W, Graefen M, Remzi M. EAU Guidelines on Reporting and Grading of Complications after Urologic Surgical Procedures. 2016
Maldonado PA, Slocum PD, Chin K, Corton MM. Anatomic relationships of psoas muscle: clinical applications to psoas hitch ureteral reimplantation. Am J Obstet Gynecol. 2014 ;211:563.e1-6. DOI: https://doi.org/10.1016/j.ajog.2014.07.008
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994 ;47:1245–51. DOI: https://doi.org/10.1016/0895-4356(94)90129-5
Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol. 2005;14:257–61. DOI: https://doi.org/10.1080/13645700500274112

How to Cite

Palagonia, E., Scarcella, S., Dell’Atti, L., Milanese, G., Schatteman, P., D’Hondt, F., De Naeyer, G., Galosi, A. B., & Mottrie, A. (2021). Robot-assisted segmental ureterectomy with psoas hitch ureteral reimplantation: Oncological, functional and perioperative outcomes of case series of a single centre. Archivio Italiano Di Urologia E Andrologia, 93(1), 101–106. https://doi.org/10.4081/aiua.2021.1.101

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.