Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

Abstract

Objective This study was performed to evaluate the outcome of complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision (RLNU-BCE), which is performed to treat urothelial carcinomas in the renal pelvis or in the ureter higher than the crossing of the common iliac artery without patient repositioning. Methods We retrospectively analyzed the clinical data of 48 patients with upper tract urothelial carcinoma who underwent complete RLNU-BCE in our institution from May 2017 to September 2019. Results RLNU-BCE was successfully performed in all 48 patients. The median operation time was 110 minutes [interquartile range (IQR), 100–130 minutes], and the median postoperative anesthesia recovery time was 10 minutes (IQR, 7–15 minutes). The median postoperative hospitalization period was 5 days (IQR, 4–6 days). Pathologic examination revealed that the margin of all resected specimens was negative. After a median follow-up of 13 months (IQR, 7–20 months), no local recurrence or distant metastasis was found. No complications occurred during follow-up. Conclusion Based on our experience with this technique, RLNU-BCE deserves application and promotion in clinical practice. Long-term comparative studies are required to confirm its superiority over other techniques.

First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique

“…The nephrectomy portion is thereby quite similar to that described by other groups utilizing retroperitoneal access for robot-assisted NU keeping in mind that none of these studies completed surgery under robotic assistance [4,12,13]. Compared to the transperitoneal approach which is currently the most common technique, we observed similar surgical characteristics with our technique.…”

“…Moreover, retroperitoneal approach might be preferential for patients with previous abdominal surgery to avoid intraperitoneal adhesions and occasionally time-consuming adhesiolysis [9]. To date, a number of studies described retroperitoneal access for robot-assisted NU, but none of these surgeries were completed under robotic assistance [4,12,13]. In the majority of cases management of the bladder cuff after robot-assisted retroperitoneal nephrectomy was only possible through intraoperative switch to either conventional laparoscopic surgery or even open surgery [4,12,13].…”

Risk Factor Analysis of Intravesical Recurrence After Laparoscopic Nephroureterectomy for Upper Tract Urothelial Carcinoma

“…Therefore, the CO 2 gas pressure during the laparoscopic procedure of LNU differs between institutions. In recent studies on LNU, laparoscopic procedures were performed with 10-14 mmHg CO 2 gas pressure [8,16,17]. It was suggested that a low CO 2 gas pressure of 8 mmHg in the present study might have in uenced the low IVR rates.…”

Systematic review and meta-analysis of completely retroperitoneoscopic nephroureterectomy versus traditional retroperitoneoscopic nephroureterectomy in upper tract urothelial carcinoma

“…[35] Next, the television monitors and surgeons switch positions, and the distal ureter with the bladder cuff is transected within a complete retroperitoneal space. [13,36] While the efficacy and safety of CRNU have not yet been fully illustrated, some studies have suggested that it may offer certain advantages over other procedures. For example, Fang et al [19] found that CRNU resulted in significantly less estimated blood loss, a shorter duration of incision drainage tube, less time to ambulation out of bed, shorter postoperative hospital stay, and less time to oral intake compared to ONU.…”