Perioperative outcomes of multiport or single-port, transperitoneal or retroperitoneal robot assisted radical nephroureterectomy: a narrative review

Background: Robot-assisted radical nephroureterectomy (RARNU), performed via either a multiport or single-port approach through transperitoneal or retroperitoneal routes, is an increasingly utilized surgical method for patients with upper tract urothelial carcinoma. Materials and methods: A collaborative review of the literature available on Medline was conducted to report the perioperative outcomes of multiport or single-port, transperitoneal or retroperitoneal RARNU. A total of 31 references published between 2006 and 2023 were included. Results: The multiport transperitoneal robotic approach has been documented in 23 studies including between 10 and 3774 RARNU. Operative times ranged from 157 to 326 minutes, intraoperative complication rates from 0% to 7.3%, estimated blood loss from 68.9 mL to 380 mL and blood transfusion rates from 1.4% to 22.7%. Overall postoperative complication ranged from 11.9% to 43.8%, with major complications occurring in 0% to 15.1% of cases. Additionally, the length of hospital stay ranged from 2.3 to 10.3 days. The single-port transperitoneal robotic approach has been documented in 3 studies including between 1 and 12 RANU. Operative time ranged from 160 to 240 minutes, with 17% of patients requiring transfusions. The length of stay varied between 3 and 7 days. Finally, five retrospective studies, including between 2 and 12 patients treated with multiport retroperitoneal RARNU and between 2 and 20 patients with single-port retroperitoneal RARNU were reported, also with satisfactory results. Conclusion: Although prospective comparative studies are needed to confirm these results, RARNU approach, whether single-port or multi-port, transperitoneal or retroperitoneal, appears promising and safe.