#201 Simultaneous Radical Nephroureterectomy and Cystectomy with HugoTM RAS… Drs. Basile & Breda

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Simultaneous Radical Nephroureterectomy and Cystectomy with HugoTM RAS after intraoperative confocal laser microscopy UTUC assessment G. Basile, A. Uleri, A. Territo, A. Gallioli, I. Sanz, P. Hernandez, P. Diana, O. Rodriguez- Faba, JM. Gaya, Y. Arce, F. Algaba, J. Palou, A. Breda Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Spain

Introduction Confocal laser microscopy (Vivascope) has not been previously used as intraoperative tool for disease risk assessment in upper tract urothelial carcinoma (UTUC). Furthermore, no reports are available regarding the usefulness of Hugo RAS in simultaneous urological oncological procedures.

Materials and Methods A man with BCG-unresponsive non-muscle invasive bladder cancer was diagnosed with a filling defect in the left renal pelvis before being submitted to radical cystectomy (RC). Thus, the patient was elected for a diagnostic ureteroscopy with intraoperative Vivascope to evaluate suspicious UTUC features before possible simultaneous radical nephroureterectomy (NFU).

Results The patient was diagnosed with a solid and multifocal tumor with high-grade features at Vivascope analysis, so, simultaneous robot-assisted NFU and cystectomy were performed with Hugo RAS. The first step was the radical NFU performed with a 4-arm configuration. For the RC, another robotic trocar and two assistant trocars were placed, while three ports of the NFU were re-adapted. The console time was 65 and 110 minutes for the NFU and RC, respectively, with an overall surgical time of 285 minutes. The length of hospital stay was 7 days. No intra and postoperative complications were recorded. The final pathology confirmed high-grade disease in the NFU specimen. No tumor recurrence was recorded at 3 months.

Conclusions Simultaneous procedures are safe and feasible with Hugo RAS. The modularity of Hugo RAS based on independent carts allows for a fast reconfiguration of the surgical setting. Intraoperative Vivascope analysis may improve the treatment decision-making process in UTUC.

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