DaVinci Xi ROtation technique for NEphroureterectomy (DRONE): a retrospective single-centre cohort study and description of a novel approach with augmented range of motion.

Robotic-assisted laparoscopic nephroureterectomy (NU) became the gold standard in the treatment of upper tract urothelial cancer (UTUC). Usually, a transabdominal approach is used. However, this approach is flawed because of the problematic range of motion and conflicting instruments, especially during the preparation of the ureter orifice in the deep pelvis. We have recently published a novel approach for nephrectomy and partial nephrectomy using the transabdominal lumbar approach (TALA). Using the DaVinci Xi system's rotation possibility, we modified TALA for NU. This includes an un- and redocking step with a 180° rotation of the robot before the dissection of the distal ureter. We have analysed the outcome of all consecutive patients who underwent DRONE at our institution. Between June 2022 and September 2024, we performed Drone on 14 patients and analysed the outcome of 13 patients (10 male/3 female, aged 55-86). The median Operation time was 226 min (158-361). Rotation time was 9 min (6-15). Median blood loss was 100 ml (0-400). Median length of stay was 6 days (5-13). Two patients had Clavien-Dindo complication (CDC) grade 2 complications, and one patient required open revision due to postoperative bleeding and intensive care corresponding to a CDC grade 4a. Our first promising report reveals that the DRONE technique is feasible and safe. The rotation step only took a few minutes and, therefore, seems straightforward. We believe that DRONE facilitates robotic NU by enhancing the range of motion and reducing instrument conflicts.