Comparative Study Of Single Position Robot-assisted Laparoscopic And Traditional Laparoscopic Radical Nephroureterectomy

Background and objectiveUrothelial carcinoma of the upper urinary tract(UTUC)is relatively rare,accounting for only 5%to 10%of urothelial carcinoma(UC).Although the overall incidence is low,it is highly invasive,highly malignant and easy to relapse and metastasize.Radical nephroureterectomy(RNU)is still the gold standard for UTUC treatment,with a wide range and span of surgical resection.With the development and popularization of laparoscopic technology and robotic surgery system,the application of laparoscopic radical nephroureterectomy(LNU)and robot-assisted laparoscopic radical nephroureterectomy(RANU)is increasing gradually.While achieving the same tumor control effect as RNU,it has the advantages of less trauma,rapid recovery and less coruplications,which has become the trend of UTUC surgery.However,there is no final conclusion as to which of the two procedures is superior or inferior.This study retrospectively analyzed the clinical data of patients who received a single position transabdominal approach RANU and LNU in our hospital,and compared the safety,effectiveness and advantages and disadvantages of the two surgical methods,so as to provide more theoretical basis for the selection of UTUC surgical methods.Subjects and methodsThe clinical data of UTUC patients who underwent single position transabdominal RANU and LNU surgery in the First Affiliated Hospital of Zhengzhou University from March 2018 to January 2021 were retrospectively analyzed,including general data,perioperative data,pathological data and postoperative follow-up data.According to the different operative methods,the patients were divided into RANU group and LANU group.There were 37 patients in RANU group and 87 patients in LNU group.The clinical data of the two groups were described and analyzed by statistical software SPSS 23.0,P<0.05 indicated that the difference between the two groups was statistically significant.Results1.Patients in both groups were diagnosed as localized UTUC before operation.There was no significant difference in sex,age,BMI,side,tumor location and tumor risk stratification between the two groups(P>0.05).2.The operations in both groups were completed successfully,and there was no conversion to open operation or change of operation and posture.Compared with LNU group,the average operation time of RANU group was longer,but the robotic arm/laparoscopic operation time and bladder suture time were shorter,the intraoperative blood loss was less(P<0.05).The total cost of hospitalization in RANU group was higher than that in LNU group(P<0.05).There were no significant differences in the intraoperative blood transfusion rate,postoperative first drinking time,postoperative first eatting time,postoperative first getting out of bed time,drainage tube indwelling time,catheter indwelling time,postoperative hospitalization time and postoperative complication rate between the two groups(P>0.05).3.There was no significant difference in pathological type,maximum diameter of tumor,pathological stage,grade,positive rate of lymph node and surgical margin between the two groups(P>0.05).4.The median follow-up time of RANU group and LNU group was 20(2-34)months and 18(1-33)months,respectively.There was no significant difference in follow-up time,the number of death and tumor progression between the two groups(P>0.05).Conclusions1.Single position transabdominal approach RANU and LNU are safe and effective surgical methods for the treatment of UTUC.There is no significant difference in perioperative complications,postoperative recovery and tumor control effect.2.Single position transabdominal approach RANU is more flexible and efficient than LNU,and can effectively reduce the time of intracavitary operation and intraoperative bleeding,but the preoperative preparation time is longer and the overall cost is higher.