Purpose: To compare the outcomes of robotic radical nephroureterectomy (RRNU) and laparoscopic radical nephroureterectomy (LRNU) within a large multi-institutional worldwide dataset. Materials and Methods: The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) includes data from 17 centers worldwide regarding 877 RRNU and LRNU performed between 2015 and 2019. Baseline features, perioperative and oncologic outcomes, were included. A 2:1 nearest-neighbor propensity-score matching with a 0.001 caliper was performed. A univariable and a multivariable logistic regression model were built to evaluate the predictors of a composite “tetrafecta” outcome defined as occurrence of bladder cuff excision+LND+no complications+negative surgical margins. Results: After matching, 185 RRNU and 91 LRNU were assessed. Patients in the RRNU group were more likely to undergo bladder cuff excision (81.9% vs 63.7%; p < 0.001) compared to the LRNU group. A statistically significant difference was found in terms of overall postoperative complications ( p = 0.003) and length of stay ( p < 0.001) in favor of RRNU. Multivariable analysis demonstrated that LRNU was an independent predictor negatively associated with achievement of “tetrafecta” (odds ratio: 0.09; p = 0.003). Conclusions: In general, RRNU and LRNU offer comparable outcomes. While the rate of overall complications is higher for LRNU in this study population, this is mostly related to low-grade complications, and therefore with more limited clinical relevance. RRNU seems to offer shorter hospital stay, but this might also be related to the different geographical location of participating centers. Overall, the implementation of robotics might facilitate achievement of a “tetrafecta” outcome as defined in the present study.

Purpose Single-port (SP) robotic surgery is a new technology and early in its adoption curve. The goal of this study is to compare the perioperative outcomes of single port (SP) to multi-port (MP) robotic technology for partial nephrectomy. Materials and Methods This is a prospective cohort study of patients who have undergone robot-assisted partial nephrectomy using SP and MP technology. Baseline demographic, clinical, and tumor-specific characteristics and perioperative outcomes were compared using χ 2, T-test and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. Results After propensity matching, 146 SP patients were matched with 146 MP patients. Single port and multiport groups had similar mean age (58 ± 12 years vs. 59 ± 12 years; p =0.606) and proportion of males (54.11% vs. 52.05%; p=0.725). The SP had a longer mean ischemia (18.29 ± 10.49mins vs. 13.79 ± 6.29mins; p <0.001). Estimated blood loss and Length of stay, operative time, positive margin rate and any complication rate were similar between the two groups. Conclusions SP partial nephrectomy had a longer ischemia time, and a comparable LOS, EBL, operative time, positive margin rates and complication rates to multi-port. This early data is encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared to the standard multi-port technique.

Purpose: To describe a novel technique for a single setup approach for robotic radical nephroureterectomy (RANU) that does not require patient repositioning, port reassignment, or redocking of the robotic arms. Materials and Methods: Twenty consecutive patients underwent RANU at a single institution between January 2009 and January 2012. We implemented a unique port placement strategy based on a modified paramedian line (MPL), which allowed sufficient access to both the upper abdomen and the deep pelvis for radical NU with bladder cuff excision and concomitant lymphadenectomy. Results: The mean operative time was 161.3 minutes (range 91–330 minutes), mean estimated blood loss was 98.8 (range 50–200), and the mean hospital stay was 3 days (median 2 days, range 1–16 days). None of the procedures were converted to open or required blood transfusions. Lymphadenectomy was performed on 16 out of 20 patients, and the mean number of lymph nodes removed per patient when lymphadenectomy was performed was 14.1 (range 2–35). Three patients had positive lymph nodes. One patient had prolonged postoperative ileus, and one had a hospital course that was complicated by pneumonia. Mean patient follow-up was 13.5 months (range 1–24 months); one patient was found to have a recurrence at 3 month follow-up. Conclusion: The use of our MPL line for novel port placement allows for an effective, efficient, and reproducible method for RANU without the need for repositioning of the patient or the robot.