Ureterectomía radical distal por cáncer urotelial y reconstrucción ureteral asistida por robot / Radical distal ureterectomy secondary to an urotelial cancer and ureteral reconstruction robot-assisted: case report

Objective: To report a case of distal ureterectomy with robotic-assisted laparoscopic reimplantation using a Boari flap technique. Material and Methods: We report a 55 year old man with a diagnosis of distal ureteral urothelial carcinoma without multifocality. Results: A radical distal ureterectomy and robotic-assisted laparoscopic vesicoureteral reimplantation using a Boari flap technique was performed with the da Vinci S-HD surgical system. The operative time was 210 minutes, the estimated blood loss was 200 mL. The hospital stay was 48 hours, without perioperative complications. The histopathological study showed a high grade non-muscle invasive urothelial carcinoma of the distal ureter (pT1NxMx) with negative margins. Conclusions: The distal radical ureterectomy with Boari replacement is feasible and more precise with robotic assistance. Its oncological role must be demostrated with a larger number of cases.

Objetivo: Comunicar un caso de tumor ureteral distal tratado con ureterectomía radical y neoimplante vesicoureteral con técnica de Flap Boari asistida por robot. Material y Métodos: Paciente hombre de 55 años, con diagnóstico de carcinoma urotelial de uréter distal sin compromiso multifocal. Resultados: Se realizó ureterectomía distal radical y neoimplante vesicoureteral con Flap Boari asistido por Robot da Vinci S-HD. El tiempo operatorio fue de 210 minutos, con un sangrado estimado de 200 ml. La estadía hospitalaria fue de 48 horas, sin complicaciones perioperatorias. El estudio histológico mostró un carcinoma urotelial de alto grado con infiltración de la lámina propia (pT1NxMx) y márgenes quirúrgicos negativos. Conclusiones: La ureterectomía radical distal con reconstrucción tipo Boari es técnicamente factible y más precisa con la asistencia robótica. Su rol oncológico requiere de validación con mayor número de casos.

Application of transurethral bipolar plasma kinetic vaporization in radical nephroureterectomy / 中国微创外科杂志

Objective To study the application of transurethral bipolar plasma kinetic vaporization of the distal ureterectomy in radical nephroureterectomy for renal pelvic or ureteral carcinoma. Methods A total of 6 patients with renal pelvic or ureteral carcinoma without involvement in ipsilateral distal ureter,ureteral orfice,and the bladder were included.Radical nephroureterectomy was performed by using transurethral bipolar plasma kinetic vaporization combined with either flank incision nephrectomy (5 patients) or retroperitoneal approach laparoscopic nephrectomy(1 patient). Results The operation was completed smoothly in the 6 patients with comparatively little blood loss.The operation time was 120~210 min(mean,150 min).Obturator nerve reflex happened in no patients during the operation.Postoperative bladder irrigation found no bleeding in the bladder.The time of indwelling the catheter was 7~9 d(mean,8 d).Hypogastralgia and fever occurred in 1 patient on the 5th postoperative day.And the patient was confirmed as having mild urinary extravasation and was given catheter indwelling for 5 days. Transuretheral cystography found no leakage and a full recovery of voiding function was achieved.Postoperative pathological findings showed negative margins in all the patients.One patient died of myocardial infarction 3 months after operation,while follow-up in the remaining 5 patients for 7~21 months(mean,16 months) showed no tumor recurrence. Conclusions Application of transurethral bipolar plasma kinetic vaporization of the distal ureterectomy is micro-invasive,with little hemorrhage and few complications.It is an effective assistant option in radical nephroureterectomy.