Robot-Assisted Radical Nephroureterectomy

Radical nephroureterectomy with formal bladder cuff excision was first proposed in 1933 for the treatment of papillomatous tumors of the renal pelvis and ureter. It is the standard of care for upper urinary tract neoplasms, as many of these tumors are characterized by multifocality, high ipsilateral recurrence rates after partial resection, and low (<5%) incidence of contralateral disease. A laparoscopic approach to nephroureterectomy was first described in 1991. A laparoscopic approach to upper tract neoplasms was increasingly adopted with evidence supporting equivalent oncologic outcomes and a faster convalescence as compared to open surgery. In more recent years, robot-assisted radical nephroureterectomy has been proposed as an alternative to laparoscopic nephroureterectomy due to the potential for improved surgeon efficiency in suturing, ergonomics, and ease of bladder reconstruction after bladder cuff excision without compromising oncologic efficacy. In the contemporary setting, robotic-assisted approaches are the current standard. In this chapter we describe the technique of robot-assisted laparoscopic nephroureterectomy.