Complete laparoscopic nephroureterectomy with intravesical lockable clip

Abstract

IntroductionWe present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized.MaterialsFrom 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy.ResultsThe mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all – mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months.ConclusionCLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder.

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

“…b In male patients, the specimen was extracted in a retrieval pouch through a lower abdominal muscle splitting incision between two auxiliary ports. c Photographs of postoperative wounds in two representative cases The Clavien-Dindo classification system [9] Several techniques, especially in excision of the distal ureter, have been reported to date [13][14][15][16]. However, we should carefully consider the application of laparoscopic surgery in patients with UTUC, which is known as one of the most aggressive malignancies.…”

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

“…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.…”

Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence

“…Many urologists combine laparoscopic or robotic RNU with open BCE via a lower abdominal incision. Alternatively, several completely minimally invasive procedures have also been reported to be feasible and safe, such as transperitoneal laparoscopic RNU with transurethral endoscopic BCE ( 5 ), pure retroperitoneal laparoscopic RNU with BCE ( 6 ), and completely retroperitoneal robot assisted RNU with BCE ( 7 ). There are various surgical combinations of RNU and BCE.…”