LAUSR

Introduction Radical nephroureterectomy with bladder cuff excision is the standard of care all high-risk upper tract urothelial carcinomas. With continued advancements, robotic-assisted segmental ureteral resection can be employed for ureteral tumors for ipsilateral renal preservation. Here in, we are presenting our experience of different techniques classified by the affected ureteral segment, along with peri-operative and intermediate to long term functional and oncological outcomes. Methods From January 2008 till June 2021, a total of 17 patients underwent robotic assisted renal preserving excisional procedures for ureteral tumors. We collected and analyzed baseline, peri-operative & follow up outcomes parameters from our prospectively maintained institutional database. Eleven patients underwent segmental ureterectomy with bladder cuff excision and ureteroneocystostomy with psoas hitch, 5 patients underwent segmental ureterectomy with uretero-ureteral anastomosis with/without psoas hitch and 1 patient underwent ileal patch interposition following segmental ureteral excision. Results Although, majority of the patients had inconclusive or low-grade pathology on initial ureteroscopic biopsies, 73.33% of the patients were found to have high grade tumors on final pathology. Median tumor size was 2.7 cm (1-5.5 cm), and the median operative duration was 193 min (142-400 min). None of the procedures required conversion to open. Overall, only one patient (5.9%) had Clavien Dindo grade >/= III complication (pelvic abscess). At median follow up of 41 months (7-156 months), 4 patients (26.67%) developed urothelial recurrences out of which only one patient required nephroureterectomy. Overall survival and nephroureterectomy free survival, was 86.67% and 92.31%, respectively. Conclusions Our study provides a comprehensive review of various surgical approaches of robotic-assisted renal sparing management for ureteral tumors. These procedures are surgically safe, feasible, and effective with satisfactory oncological outcomes at intermediate to long term follow up. These procedures may be safely employed in select patients with a localized ureteral tumor to salvage the ipsilateral kidney and eGFR.