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Standard treatment for ureteral cancer is surgical resection of the tumor, called a distal ureterectomy, or removal of the entire kidney, called a nephro-ureterectomy. Depending on the experience of the surgeon, this procedure can be performed using open surgery, while others may elect a laparoscopic approach. In either instance, the surgeon's experience is vital for preserving function of the kidney.
"A minimally invasive approach to this procedure is challenging for even the most experienced laparoscopist. This is due to the technical challenge of re-implanting the ureter into the bladder," says Rosalia Viterbo, MD, robotic surgeon at Fox Chase and co-author on the study. "Robotic assistance can make a minimally invasive approach more technically feasible."
In this video abstract, Fox Chase urologic cancer surgeons, Viterbo and her colleague David Y.T. Chen, MD, demonstrate the four-arm technique for robot assisted distal ureterectomy.
In the video, Viterbo is shown performing the robotic distal ureterectomy on a 73-year-old man with a distal left ureteral tumour. She explains, "The patient presented with stage 3 chronic kidney disease, so a nephron-sparing approach was taken to preserve kidney function. During the surgery, the four robotic arms and two assistant ports were successfully positioned in a manner similar to robot assisted radical prostatectomy."
This approach resulted in the usual benefits associated with minimally invasive surgeries, such as less bleeding and scarring, shorter hospital stay, faster recovery and return to normal activity and with his kidney function preserved.