Three experienced nephroureterectomy practitioners will discuss the emergence of robotic surgery as the new gold standard for nephroureterectomy during a Surgical Techniques session Monday afternoon. The hour-long session, titled Tips & Tricks: Nephroureterectomy, will begin at 2 pm in the Esplanade Ballroom at Moscone South.
Ashok Hemal, MD, Professor of Urology and Chief of Uro-oncology at Wake Forest University Institute for Regenerative Medicine, said open surgery was once the standard treatment for high-risk upper tract urothelial carcinoma (UTUC). But with the rise in minimally invasive alternatives to genitourinary pathologies, laparoscopy was adopted.
“The drawback to the laparoscopic approach lies within the excision of the distal ureter and the bladder reconstruction portion of the procedure,” he said. “In addition, it’s an ergonomically challenging procedure for the operating surgeon. With the advancement of robotic assistance, especially with improved instrumentation and enhanced 3D visualization, this major ablative and reconstructive procedure has become more technically feasible, leading to the increased adoption of this technology.”
Dr. Hemal will present intermediate and long-term oncologic data for robot-assisted nephroureterectomy. He will also compare results from the open, laparoscopic and robotic approaches.
“With this session, attendees will have exposure to all the techniques available for this complex surgery so they can make the best choice for their practice and for their communities,” he said
The second surgeon, Surena Matin, MD, FACS, the Monteleone Family Foundation Endowed Professor in the Department of Urology at MD Anderson Cancer Center, said nephroureterectomy skills are critical because of the unforgiving nature of UTUC.
“This is a particularly important procedure to address because currently there’s a lot of variation in surgical technique across the profession,” he said. “And this cancer is unforgiving. This cancer will take advantage in any breach in surgical technique — any shortcuts, whether open, laparoscopic or robotic. There’s really no standardization for nephroureterectomy, so it’s not unusual for there to be a breach in the oncological approach.”
Dr. Matin will highlight specific problem areas of the procedure and will review his strategies for overcoming them. For example, he will review his strategy for addressing the distal ureter and the bladder cuff, showing how to standardize that process and make it amenable to a robotic approach that does not require repositioning or re-docking. He will also explain how he simultaneously incorporates lymph node dissection with his robotic approach, and will share retrospective data he published comparing the robotic approach to the laparoscopic approach.
Also during the session, Arieh Shalhav, MD, Chief of Urologic Surgery and Director of Robotic Surgery at the Comprehensive Cancer Research Center at the University of Chicago, will discuss how robotic nephroureterectomy can improve safety, increase efficiency and reduce morbidity.
“It’s important to demonstrate the superior safety and efficiency when it’s done robotically, and to demonstrate how a very thorough lymph node dissection can be performed robotically,” Dr. Shalhav said. “Attendees will learn tips and tricks for how to make the procedure seamless, even for surgeons with less experience.”