Rotational reconfiguration for single-position radical nephroureterectomy with bladder cuff excision on the Xi platform

Abstract

Aim: To establish and describe a standardized single-position workflow for robot-assisted radical nephroureterectomy with bladder cuff excision (RANU + BCE) using the da Vinci Xi platform. This approach features a dual-rotation reconfiguration, allowing a seamless transition from the renal to the pelvic field without repositioning the patient.

Methods: A retrospective, single-center series of 37 patients with upper tract urothelial carcinoma (UTUC) undergoing transperitoneal Xi RANU + BCE. The rotational reconfiguration commenced with a 90° axial rotation of the multichannel single-site platform - clockwise for left-sided and counterclockwise for right-sided UTUC (as observed externally on the platform). This was followed by coordinated patient-cart axis rotation and overhead-boom adjustment to achieve a pelvic suturing view (12 → 3 for left-sided; 12 → 9 for right-sided), without altering port sites or patient position.

Results: All procedures were completed without repositioning; there were no conversions or reoperations. The median docking time was 15.00 min [interquartile range (IQR) 13.0-19.5], and the median console time was 150.0 min (IQR 121.50-175.50). Estimated blood loss was 50 mL (IQR 20.00-50.00). Hemoglobin reduction was 11.48% on postoperative day (POD) 1 and 10.20% on POD 3. Serum creatinine increased by 8.09% on POD 1 and 18.80% on POD 3. Postoperative complications occurred in 2/37 patients (5.41%), with no complications graded Clavien–Dindo ≥ III.

Conclusion: This integrated Xi workflow may enable a reproducible renal-to-pelvic transition and may help maintain continuous exposure for bladder cuff management without patient repositioning. The straightforward disengage–rotate–re-engage arm choreography allows flexible traction under surgeon discretion and facilitates team adoption and process standardization.

Keywords

Robot-assisted / single-position / upper tract urothelial carcinoma

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