Introduction: Performing a robotic-assisted laparoscopic nephroureterectomy can be challenging, especially during the distal ureterectomy and bladder cuff portion. We demonstrate how the Da Vinci Single Port Robot facilitates certain portions of the case. We show how the procedure can be performed with one incision compared to a multiport robotic or open technique.
Methods: A 73 year old male was diagnosed with a high grade urothelial cancer of the right renal pelvis on ureteroscopic biopsy. He then underwent neoadjuvant chemotherapy. He also has a horseshoe kidney, making the case more complex than a regular nephroureterectomy.
Patient underwent single port robotic assisted laparoscopic right nephroureterectomy with bladder cuff.
Results: A single 25mm incision was made supraumbilically for the robotic instruments. No assistant port was used, making this a true single port procedure. The remotely operated suction irrigation system (ROSI) was used not only for suction but dissection as well. The operative time for the case was 187 minutes. Estimated blood loss was 150cc. The patient was discharged within 18 hours of surgery with a foley catheter and no need for post op narcotic use.
Even though there is limited space underneath the liver, we were able to work underneath the liver without the use of a liver retractor by using the elbow of our 4th arm to hold it up. We use the “Relocate” function of the SP Robot to perform our distal ureterectomy and bladder cuff portion, preventing the need to re-dock the robot. We performed multiple procedures with one incision: partial nephrectomy, distal ureterectomy with bladder cuff and lymphadenectomy. At our institution, we have performed seven robotic single port nephroureterectomies. Average operating time is 126 minutes, estimated blood loss 92cc and average length of stay is 1.8 days.
Conclusions: The use of the Da Vinci Single Port robot can make increasingly complex cases even more minimally invasive. This can reduce post-operative pain, improve cosmesis and shorten hospital stay. However there is a learning curve in the use of the Da Vinci SP robot. We hope to improve our techniques and surgical approaches further to keep our procedures as minimally invasive as possible.