Laparoendoscopic single-site robot-assisted nephroureterectomy: Comparison with the conventional multiport laparoendoscopic technique for upper tract urothelial carcinoma in the retroperitoneal approach

Objective To evaluate the feasibility and safety of robot-assisted single-port laparoendoscopic nephroureterectomy by comparing peri-operative, pathological, and oncological results with conventional multiport laparoendoscopic approach in retroperitoneal approach for the management of upper urinary tract urothelial carcinoma (UTUC). Methods Between January 2021 and October 2024, our center treated 56 patients with urinary tract urothelial carcinoma using either the robot-assisted single-site laparoendoscopic nephroureterectomy (LESS-RANU) ( n =31) or the conventional multi-port laparoscopic nephroureterectomy (LNU) ( n =25) via a retroperitoneal approach. Data including demographic, peri-operative, pathological, and oncological characteristics were collected. Results No significant differences were found in patient demographics and tumour characteristics between two groups. No serious intra-operative complications occurred in both groups. The mean operation time, skin incision length, Visual Analog Scale pain scores, time for reposition and follow-up duration for LESS-RANU group and LNU group were 138.23 min and 180.40 min, 6.48 cm and 15.40 cm, 3.23 and 4.60, 5.71 min and 30.27 min, and 10.84 months and 22.88 months, respectively ( p <0.01). There were no significant differences in other perioperative data between the two groups. Multiple linear regression identified an association of body mass index with operation time in LESS-RANU group ( p <0.01). The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients (130.33 min vs. 145.31 min, p =0.044). There were no significant differences in the pathological characteristics between the two groups. The mean follow-up was 10.84 months in LESS-RANU group and 22.88 months in LNU group ( p <0.01). Recurrences developed in 4 patients: 1 in the LESS-RANU group and 3 in the LNU group. Conclusion LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach, especially for patients with low body mass index.