Robotic nephroureterectomy for complex renal anatomy

Purpose: This study aimed to present our technique of robotic nephroureterectomy in two cases of upper tract transitional cell carcinoma in patients with complex renal anatomy.Surgical Methods: Case 1 was a 54-year-old male with horseshoe kidney and renal insufficiency (GFR 42) and left upper tract high-grade urothelial carcinoma as confirmed via endoscopic biopsy, whereas Case 2 was a 61-year-old male with an atrophic left kidney (GFR 65) and high-grade T1 urothelial carcinoma in the upper moiety of a duplicated right system treated with neoadjuvant chemotherapy.These cases required the application of the principles from both partial nephrectomy and nephroureterectomy.Results: No complications were observed for either case.Cases 1 and 2 were discharged on POD 1 and POD 2, respectively.The pathology for Case 1 was pT3N0 invasive papillary urothelial carcinoma with negative margins, while that for Case 2 was pTis/TaN0 high-grade urothelial carcinoma with negative margins.Both patients were disease-free and showed a remarkable residual GFR after surgery (a GFR of 32 for Case 1 and a GFR of 33 for Case 2).Conclusions: Robotic nephroureterectomy is considered a safe and feasible alternative to open or laparoscopic approaches for the management of upper tract urothelial carcinoma.It allows the complete removal of the distal ureter with bladder cuff in accordance with the established oncologic principles.