A Novel Technique of Traction Pre‐Bladder Suturing in Single‐Position Robot‐Assisted Nephroureterectomy: Simplifying the Management of the Intramural Ureter

OBJECTIVE: To evaluate the feasibility and preliminary perioperative outcomes of a traction pre-bladder suturing technique for managing the intramural ureter during single-position robot-assisted laparoscopic nephroureterectomy (RALNU) in patients with early-stage upper tract urothelial carcinoma (UTUC). METHODS: 10 consecutive patients with early-stage UTUC underwent RALNU (Oct 2022-Aug 2023). The technique involves four steps: mucosal tenting, a purse-string suture for containment, en bloc resection of the protruding mucosa and ureter, and reinforced double-layer bladder closure. RESULTS: All procedures were successful. Mean operative time was 145 min, with 38 min dedicated to the intramural segment. Mean blood loss was 35 mL, with no conversions or major complications. Pathology confirmed R0 resection of low-grade noninvasive carcinoma. Two metachronous bladder recurrences occurred during a median 12-month follow-up. CONCLUSION: This technique appears to be a feasible approach in patients with early-stage UTUC, with the potential to minimise urine spillage and facilitate secure bladder closure during RALNU.