A novel technique for distal ureterectomy and bladder cuff excision

Sotelo, René; Ramírez, Daniel; Carmona, Oswaldo; Grazia, Eugenio Di; Andrade, Robert De; Giedelman, Camilo; Pascal, Z.; Gill, Inderbir S.; Desai, Mihir

doi:10.1016/s2173-5786(11)70044-0

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…In a case report by Sotelo et al [15], they performed a transvesical single-site surgery enabling full-thickness incision of the bladder around the ureteral orifice, followed by a water-tight suture of the bladder wall defect. Transvesical single-site surgery requires insertion of a special device into the bladder and subsequent suture of the bladder anterior wall.…”

Section: Discussionmentioning

confidence: 99%

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Miyake¹,

Nishimura

Aoki

et al. 2020

Preprint

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Background: Selecting the treatment procedure for cancer patients is a challenging task. We report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).Methods: A total of four patients with UTUC underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien–Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU, consisting of laparoscopic nephrectomy with open bladder cuff excision) for pain scale evaluation.Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period (median, 10 months). Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31).Conclusions: We described our initial experience and outcome of complete laparoscopic RNU for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.

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Section: Discussionmentioning

confidence: 99%

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Miyake¹,

Nishimura

Aoki

et al. 2020

Preprint

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“…In this study, we report the initial experience of complete laparoscopic RNU with transvesical laparoscopic bladder cuff excision in patients with UTUC. Several techniques, especially in excision of the distal ureter, have been reported to date [12][13][14][15]. However, we should carefully consider the application of laparoscopic surgery in patients with UTUC, which is known as one of the most aggressive malignancies.…”

Section: Discussionmentioning

confidence: 99%

“…In a case report by Sotelo et al [15], they performed a transvesical single-site surgery enabling fullthickness incision of the bladder around the ureteral orifice, followed by a water-tight suture of the bladder wall defect. Transvesical single-site surgery requires insertion of a special device into the bladder and subsequent suture of the bladder anterior wall.…”

Section: Discussionmentioning

confidence: 99%

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Miyake

Nishimura

Aoki

et al. 2020

Preprint

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Background: Selecting the best treatment procedure for cancer patients is a challenging task in clinical practice. Here, we report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC). Methods:We reviewed patients with UTUC who underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis.Peri-operative complications were evaluated using the Clavien-Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU) for pain scale evaluation.Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period.Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31, Mann Whitney U test). Conclusions:Few studies have reported on transvesical three-port bladder cuff excision for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value. initial clinical case report. J Laparoendosc Surg. 1991;1:343-9. 4. Ni S, Tao W, Chen Q, et al. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2012;61:1142-53. 5. Zhang X, Wang K, Ma J, et al. Total laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma under a single surgical position. World J Surg Oncol. 2019;17:65.6. Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010;57:963-9. 7. Casale P, Kojima Y. Robotic-assisted laparoscopic surgery in pediatric urology: an update. Scand J Surg. 2009;98:110-9. 8. Badawy H, Eid A, Hassouna M, et al. Pneumovesicoscopic diverticulectomy in children

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“…In the initial 4 cases we did the technique that we described in 2011 [9], and in the last case we did some modifications including the use of running barbed suture to closure the bladder defect, and changes in the sequence of the surgery. All patients were evaluated peroperatively and no concomitant bladder tumors were found.…”

Section: Methodsmentioning

confidence: 99%

“…After checking for any leak or bleeding, the multiport is removed and the bladder is closed. At this point we continue with the nephrectomy by standard laparoscopy [10] or LESS [9] as a second stage. The ureter is dissected caudally into the pelvis until identification of the distal segment with the Hem-o-Loc®.…”

Section: Surgical Techniquementioning

confidence: 99%

Transvesical laparoendoscopic single-site management of distal ureter during laparoscopic radical nephroureterectomy

Bragayrac¹,

Machuca²,

Saenz³

et al. 2014

Journal of Endourology

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Journal of EndourologyTransvesical laparoendoscopic single-site management of distal ureter during laparoscopic radical nephroureterectomy (Abstract Objective: To describe the management of the distal ureter during radical nephroureterectomy with T-LESS approach.Methods: Between January 2010 and October 2013, five patients underwent LRNU for upper urinary tract carcinoma with T-LESS approach. Patients were placed in supine position. A 2.5 cm skin incision was made in the line between the pubis and the umbilicus.The bladder identified and a multiport was inserted into the bladder. The patients were repositioned to a lateral decubitus position, pneumovesicum was established and the ureteral openings were identified.We marked the bladder cuff with electrocautery all the way through to the extravesical fat.The bladder defect was sealed with suture. After checking for any leak or bleeding, the multiport was removed and the bladder was closed. At this point we continued with nephrectomy by standard laparoscopy or LESS. A 18 French Foley catheter was placed into the bladder.Results: The mean age was 70 years (range 58 years to 81 years), mean operative time was 198 minutes (range 115 min to 390 min), the mean time for the management of the distal ureter was 35 minutes (range 27 min to 45 min), mean estimated blood loss was 234 cc (range 60 cc to 850 cc), mean hospital stay was 3,8 days (range 2 days to 8 days). In all patients the bladder cuff was free of disease.Conclusion: The transvesical laparoendoscopic single site approach to the distal ureter for upper urinary tract carcinoma appears safe and reproducible, with faster closure of the bladder defect and improved cosmesis.

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A novel technique for distal ureterectomy and bladder cuff excision

Cited by 12 publications

References 27 publications

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Transvesical laparoendoscopic single-site management of distal ureter during laparoscopic radical nephroureterectomy

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