Introduction: Radical nephroureterectomy (RNU) is the standard treatment for high grade upper tract urothelial carcinoma (UTUC). Robotics have shown comparable oncological outcomes with potential advantages in terms of perioperative morbidity compared to standard open approaches. En-bloc removal of the distal ureter and the bladder cuff excision is critical to achieve adequate oncologic control and minimize local recurrences. The “Keyhole” technique allows for an en-bloc extraction by providing direct visualization of the edges of bladder resection and ureteric orifices. We describe our initial experience with this technique for the distal ureter and bladder cuff excision during robotic RNU.
Methods: Between 2015 and 2020, eighteen patients who underwent robotic RNU with bladder cuff resection using the keyhole technique were retrospectively reviewed. Baseline characteristics, surgical and pathological outcomes were collected. Complications were reported using the modified Clavien-Dindo classification system.Continuous variables were depicted as median and quartiles, whereas categorical variables as frequencies and percentages.
Results: Eighteen patients with median follow-up of 26 months were included in this study. Table 1 shows clinico-pathologic and perioperative outcome of these patients. Keyhole technique was feasible in all cases with no intraoperative complications. One urine leak (grade II) was recorded and managed conservatively with a catheter. Bladder recurrence was reported in six (33%) cases with a median time of 11 months (5-30).
Conclusions: The Keyhole technique for the management of distal ureter and bladder cuff during robotic RNU is a feasible approach with minimal 90-day complications.