In the realm of robotic-assisted surgeries, the DaVinci Xi ROtation technique for NEphroureterectomy (DRONE) presents a novel approach to treating upper tract urothelial cancer (UTUC). Traditionally, the transabdominal approach has been the gold standard for nephroureterectomy (NU); however, it often encounters challenges related to instrument conflicts and limited range of motion, particularly in the deep pelvis. This study introduces DRONE, a modification of the transabdominal lumbar approach (TALA), which aims to enhance surgical outcomes by improving the range of motion during robotic NU procedures.

Study Design and Methods

The retrospective cohort study analyzed the outcomes of consecutive patients who underwent the DRONE technique at the Cantonal Hospital Baden between June 2022 and September 2024. A total of 14 patients were initially included, but outcomes were analyzed for 13 patients after one declined participation in the study. Patient demographics included 10 males and 3 females, with a median age of 72 years. The study was ethically approved and noted for its focus on surgical technique and outcomes.

Surgical Technique: DRONE

The DaVinci Xi Rotation technique for Nephroureterectomy – DRONE technique involves three major steps:

1. Nephrectomy: The robot is docked using the TALA approach, allowing access to the kidney through a mini-laparotomy at the lumbar line. The kidney is mobilized, and the renal vessels are dissected without instrument conflicts due to the favorable positioning provided by this approach.
2. Rotation of the DaVinci Xi: After completing the nephrectomy, the robotic system undergoes a 180-degree rotation without altering the patient’s position or trocar locations. This maneuver enhances the range of motion for subsequent procedures.
3. Dissection of the Distal Ureter: With the patient repositioned in a Trendelenburg position, the distal ureter is dissected, ensuring optimal exposure and minimizing conflicts between instruments.

This innovative approach aims to facilitate robotic NU by improving maneuverability and reducing the likelihood of complications.

Results

The study reported a median operation time of 226 minutes, with a rotation time of approximately 9 minutes. The estimated blood loss during procedures averaged 100 mL. Additionally, the median length of hospital stay was 6 days, and postoperative complications included two patients with Clavien-Dindo grade 2 complications and one patient requiring open revision due to a grade 4a complication resulting from postoperative bleeding.

The outcomes indicated that the DRONE technique is both feasible and safe, with a significant portion of patients experiencing non-opioid analgesia during recovery. The follow-up revealed two local recurrences in the bladder but no systemic recurrences, highlighting the potential effectiveness of the DRONE technique in managing UTUC.

Discussion

The DRONE technique represents a significant advancement in robotic surgery for UTUC, offering several advantages over traditional approaches. The combination of TALA and the rotational capabilities of the DaVinci Xi system allows for enhanced surgical precision and reduced instrument conflicts, which are critical in complex surgeries.

While the study presents promising initial results, it acknowledges limitations such as the small sample size and the retrospective nature of the analysis. Future studies with larger cohorts and longer follow-up periods are essential to validate the oncological outcomes associated with this technique.

Conclusion

In conclusion, the DaVinci Xi Rotation technique for Nephroureterectomy technique for nephroureterectomy offers a promising alternative to conventional surgical methods for upper tract urothelial cancer. By enhancing the range of motion and reducing instrument conflicts, this approach may lead to improved surgical outcomes and patient recovery experiences. Further research is warranted to establish long-term oncological benefits and refine the technique for broader application across various robotic surgical platforms.

READ MORE… https://link.springer.com/article/10.1007/s11701-025-02230-7

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