#365 R R C and Nephroureterectomy for Urothelial Carcinoma in a Double-Renal Transplant Recipient

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans at 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. Dr. Alessandro Marquis

From the entry: Title Robotic Radical Cystectomy and Nephroureterectomy for Urothelial Carcinoma in a Double-Renal Transplant Recipient

Authors Alessandro Marquis1, Marco Allasia1, Marco Oderda1, Simone Livoti1, Federico Lavagno1, Giancarlo Marra1, Francesco Soria1, Paolo Gontero1

Affiliations 1Urology Unit, Department of Surgical Sciences, University of Turin School of Medicine, AOU Città della Salute e della Scienza, Molinette Hospital

Introduction & Objectives Renal transplant recipients (RTRs) have a 2- to 7-fold lifetime risk of developing a neoplasm compared to general population. Here, bladder urothelial carcinoma (UC) has an incidence of 0.4-2% while in the upper tract (UT) it is relevant only in the context of aristolochic acid nephropathy. The aim of this video is to illustrate an interesting and unusual case of robotic surgery.

Material & Methods A 29 y.o. solitary kidney male who previously underwent double renal transplants (2016 right and 2020 left iliac fossa) presented with hematuria and positive high grade cytology. At CT-scan and transurethral resection, a wide UC of the distal right graft ureter extending to the bladder was detected. The histology revealed a pT2HGG3 UC with CIS. After multidisciplinary discussion, robotic RC and right renal-graft radical nephroureterectomy (RNU) with prophylactic bilateral native ureterectomy and Florence robotic intracorporeal neobladder (FloRIN) was planned.

Results The procedure successfully completed. Technical aspects of the surgery are illustrated in the video. No intra- and postoperative complications were recorded. Operative time was 420min. Blood losses were 200mL. The monoJ was removed after two weeks, while the urinary catheter 3 weeks after a negative cystogram. The patient recovered full early urinary continence. The final pathology revealed a bladder pT2aG3HG UC and a pelvis and ureteral pT1G3HG UC with CIS.

Conclusions Robotic RC and renal-graft RNU with FloRIN is a safe and reproducible procedure, guaranteeing good functional outcomes and low complications rate.

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