Introduction: Need for renal function preservation may influence the decision to take a nephron sparing approach of segmental ureterectomy for localized ureteral tumors, as an alternative to radical nephroureterectomy. In this video we demonstrate four different individualized surgical techniques tailored according to patient’s disease. Methods: All the surgeries were performed by single surgeon (AKH) using da Vinci (Si/Xi) robotic surgical system. For distal ureteral tumors, distal ureterectomy with bladder cuff excision/partial cystectomy with pelvic lymph node dissection (PLND) and uretero-neo-cystostomy was performed in 11 patients. Proximal ureteral tumors were addressed with segmental ureterectomy and uretero-ureterostomy in 5 patients and another patient underwent augmented anastomotic ureteroplasty using free circumferential ileal patch. Regardless of the surgical approach adopted, complete preoperative evaluation was carried out with cross sectional imaging and other investigations (renogram, retrograde pyelogram & nephrostogram) as indicated. These procedures were considered in carefully selected patients with unifocal disease associated with medical co-morbidities, advancing age, and compromised renal function. Intraoperative fluoroscopy guided navigation and/or molecular imaging using indocyanine green (intraluminal or intravascular) are also helpful. Results: In this video, we have demonstrated four such techniques, including our novel approach of augmented anastomotic ureteroplasty with free circumferential ileal patch to bridge a significant defect following segmental ureterectomy. We have also highlighted our novel technique of intra-corporeal JJ stent placement. No intra or post operative complications were noted, and all the surgical margins were negative. JJ Stents was removed in about 4 weeks post-operatively. Conclusions: Robot-assisted patient-tailored approach for ureteral tumors may be effectively employed in appropriately selected patients of ureteral tumors with excision and end to end anastomosis, augmented anastomosis or uretero-neo-cystotomy with psoas hitch as an alternative to radical nephroureterectomy to salvage the ipsilateral kidney. SOURCE OF Funding: None
