Complete transperitoneal laparoscopic nephroureterectomy in a single position for upper urinary tract urothelial carcinoma and comparative outcomes

Abstract

Background To describe the techniques and outcomes of complete transperitoneal laparoscopic nephroureterectomy (CTLNU) for upper urinary tract urothelial carcinoma (UTUC) in a single position. Materials and methods Those patients with localized UTUC were included, among which 50 cases had CTLNU while 48 cases had laparoscopic nephroureterectomy with open bladder cuff excision (LNOBE). The clinical data were collected and analyzed retrospectively. Results All 98 patients underwent successful procedures of radical nephroureterectomy without transferring into open surgery. No significant difference was found among baseline clinical characteristics. Compared with the LNOBE group, the CTLNU group had a shorter operative time (98.5±40.3 min vs. 132.4±60.2 min), less blood loss (60.4±20.3 ml vs. 150.6±50.2 ml), shorter length of hospital stay (5.3±2.2 days vs. 8.1±2.3 days), and shorter incision (6.3±1.2 cm vs. 11.5±3.2 cm). The disease-related outcomes such as pathological stage, tumor grade, and recurrence rate were similar between the two groups. Conclusions The CTLNU in a single position had advantages of shorter operation time, less blood loss, and shorter incision length. This surgical technique is a more minimally invasive, simplified, and effective way to perform the radical nephroureterectomy.

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

“…[23] Due to its advantages over ONU, such as less requirement for transfusion, less blood loss, and shorter hospital stay, laparoscopic nephroureterectomy has been widely accepted worldwide as a promising option. [24] Currently, several different laparoscopic procedures are used for the treatment of UTUC, such as TRNU, [5] tRNU, [6,7] hand-assisted laparoscopic nephroureterectomy [25,26] and robotic-assisted laparoscopic technique. [27,28] In all of these procedures, dealing with the bladder cuff is a key process.…”

“…[1] Because of the inherited behavior of urothelial carcinoma, radical nephroureterectomy with bladder cuff excision is considered the standard management for UTUC, particularly for muscle-invasive and/or high-grade disease. [2] Currently, open nephroureterectomy (ONU), [3,4] traditionally retroperitoneoscopic nephroureterectomy (TRNU), [5] and transperitoneal laparoscopic radical nephroureterectomy (tRNU) [6,7] are commonly used surgical procedures for treating UTUC. However, none of these procedures results in a completely laparoscopic method because the excision of the bladder cuff is done through an abdominal incision.…”

“…Currently, open nephroureterectomy (ONU), [3,4] traditionally retroperitoneoscopic nephroureterectomy (TRNU), [5] and transperitoneal laparoscopic radical nephroureterectomy (tRNU) [6,7] are commonly used surgical procedures for treating UTUC. However, none of these procedures results in a completely laparoscopic method because the excision of the bladder cuff is done through an abdominal incision.…”

Comparison of Oncological Outcomes between Transperitoneal and Retroperitoneal Approaches in Laparoscopic Nephroureterectomies for Upper Tract Urothelial Carcinoma

“…According to the European Association of Urology guidelines, an LNU is the standard surgical treatment for pT2 UTUC or lower [ 6 ]. Bladder cuff resections have been generally performed using the open method (cLNU: conventional LNU), but in recent years, there have been reports of pure LNUs (pLNUs) in which the entire surgery is completed laparoscopically [ 7 , 8 , 9 ]. There have been many reports of a transperitoneal approach to pure LNUs.…”