Modified transperitoneal versus retroperitoneal laparoscopic radical nephroureterectomy in the management of upper urinary tract urothelial carcinoma: Best practice in a single center with updated results

Abstract

Objective Radical nephroureterectomy remains the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Based on previous research, we prospectively compared the advantages of transperitoneal laparoscopic radical nephroureterectomy (TLNU) with a three-port technique in a single position versus retroperitoneal laparoscopic radical nephroureterectomy (RLNU). Methods We evaluated 48 patients diagnosed with UTUC at our institution from January 2015 to October 2019. The patients underwent either TLNU (n = 24) or RLNU (n = 24). We randomly assigned the patients to each technique group based on their body mass index because our experience has shown that the body mass index is the main interfering factor for this surgery. The baseline characteristics and perioperative outcomes were compared between the groups. Results We found no significant differences in the baseline characteristics, time until recovery of intestinal function, or postoperative hospital stay between the two groups. However, the TLNU group had a shorter operation time and better postoperative pain control than the RLNU group. Conclusion Modified TLNU is associated with a shorter operative time and less severe postoperative pain compared with RLNU. Both techniques are safe and reliable with adequate management, and their therapeutic effects are comparable in other aspects.

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence

“…RLRN has smaller surgical incision, less postoperative pain, and less impact on gastrointestinal function of patients, which can help patients recover gastrointestinal function at an early stage, shorten postoperative feeding time of patients, and enable patients to get out of bed and exercise as soon as possible. Moreover, RLRN has less trauma, clear surgical approach, no need for incision of the peritoneum, and less separated abdominal tissues, which can avoid long-term exposure of abdominal organs, effectively improve the injury and pollution of other abdominal organs, and contribute to postoperative recovery [ 26 , 27 ]. The results of this study showed that the total incidence of postoperative complications in the observation group was lower than that in the control group, and the levels of serum IL-6 and TNF- α were lower than those in the control group.…”

Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and pooled analysis of comparative outcomes

“…Ultimately, we determined six studies published between 2016 and 2022 that passed our initial title and abstract screening. One study was a prospective non-randomized controlled trial [ 11 ], while the other five studies were retrospective observational case–control studies [ 12 – 16 ]. One of the trials is a multi-center study [ 13 ].…”

“…Six studies [ 11 – 16 ] reported postoperative complications, such as postoperative bleeding, fever, intestinal obstruction, etc. No statistically significant difference was observed between the two surgical approaches in the incidence of Clavien-Dindo grade I ( P = 0.78) and grade II ( P = 0.62) (Fig.…”

Transurethral Hem-o-lok Clip Ligation of the Distal Ureter in Retroperitoneal Laparoscopic Radical Nephroureterectomy

“…In this approach, the lower segment of the ureter including the intramural ureter is managed in the same position. Although this operation is performed under direct vision, difficulties such as operator discomfort and unsatisfactory surgical field of view remain [3, 15, 16]. In addition, the patients still need a lithotomy position to have cystoscopy to treat the potential bladder tumor pre-operation.…”