Hand-Assisted Retroperitoneoscopic Nephroureterectomy With Bladder Cuffing After Preperitoneal and Retroperitoneal Perivesical Ballooning

Abstract

PurposeWe aimed to describe the surgical technique of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) with bladder cuffing after preperitoneal and retroperitoneal perivesical ballooning.Materials and MethodsFrom March 2008 to September 2012, we performed HARNU and open bladder cuffing in 28 consecutive series of patients with upper urinary tract urothelial carcinoma. We performed HARNU according to the following procedure: (1) a camera port incision was made on the posterior axillary line; (2) multiple, repeated, preperitoneal and retroperitoneal ballooning was performed on both the posterior axillary line and in the umbilicus; (3) a 7.0 cm skin incision was made from the suprapubic to the lower inguinal with the balloon present in the extraperitoneal area; (4) hand-assisted laparoscopic retroperitoneal nephroureterectomy; (5) cessation of gas insufflation; and (6) extravesical cuffing as an open surgical procedure.ResultsThe mean estimated blood loss was 250 mL. The mean operation time was 240 minutes. The mean time to oral intake and ambulation was 1.0 day and two days, respectively. As for postoperative complications due to the hand-assisted device, one patient developed febrile urinary tract infection within three weeks postoperatively and was hospitalized again to receive parenteral antibiotics.ConclusionsWe made a low Gibson incision for a route for the hand-assisted procedure as well as a window for open surgery in dissecting the distal ureter and extracting the surgical specimens. Thus, our results indicate that the HARNU might be a feasible surgical modality.

Total laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma under a single surgical position

“…Laparoscopic surgery is one of the main surgical solutions for UUTUC [2, 3]. Retroperitoneal laparoscopic nephroureterectomy plus transurethral electric resection of the bladder cuff has been widely applied for treating UUTUC [4, 5]. In recent years, studies have shown that retroperitoneal laparoscopy combined with hypogastric oblique incision has more obvious advantages [6, 7].…”

Clinical application of one-position complete retroperitoneal laparoscopic radical resection of renal pelvis and ureteral carcinoma

“…With the advancement of laparoscopic techniques and the accumulation of operative experience, laparoscopic total nephroureterectomy with excision of bladder cuff have been applicable to a growing number of pelvic ureteral cancer patients in many centers since it was successfully performed by Clayman et al in 1991[5,6]. Recently, laparoscopic nephroureterectomy has replaced open surgery as standard surgical treatment for upper urinary tract epithelial carcinoma bacause of the less intraoperative bleeding, minimal invasion, quicker recovery and shorter postoperative hospital stay[7][8][9][10][11].At present there are many surgical approaches for laparoscopic nephroureterectomy. The most common method was the Bishoff method[12], that is, laparoscopic renal and upper ureter resection in the upper abdomen, and lower ureter and partial bladder incision in the lower abdomen.…”