Radical Nephroureterectomy Without Patient or Port Repositioning Using the Da Vinci Xi® Robotic System: Initial Experience Abstract



To report our initial experience on robot assisted radical nephroureterectomy (RARNU), using da Vinci Xi®robotic system without patient or port repositioning.


The patients are positioned in a modified flank position. A Bugbee electrode is used to cauterize and mark the ureteral orifice aiding in the final robotic excision of the distal ureter. For the first step of the procedure, 2nd robotic arm holds the scope, 4th robotic arm holds port #1 (mono-polar curved scissors), 1st robotic arm holds Port #2 (Fenestrated bipolar forceps), 3rd robotic arm holds Port #4 (Prograsp forceps). After completion of nephrectomy, all robotic arms are released and reconfigured. In the new setting, the 3rd robotic arm and 2nd robotic arms are switched between the camera port and 4th port. The 1st port remains working with the monopolar curved scissors while prograsp forceps is moved to the 2nd port and fenestrated bipolar forceps is moved to the 3rd port.


Two patients underwent 2 successful radical nephroureterectomies with the above-mentioned technique. The console time for the first patient was 150 minutes whereas the estimated blood loss was 200 ml. The console time and blood loss for the second patient were 140 minutes and 300 ml. respectively. The hospitalization time and catheter removal time were for both patients 3 days and no complications were observed.


The use of Da Vinci Xi® robotic system enabled us to perform both nephrectomy and distal ureterectomy/bladder cuff excision without any repositioning of the patient or trocars.