Transvesical laparoendoscopic single-site management of distal ureter during laparoscopic radical nephroureterectomy

Abstract

Journal of EndourologyTransvesical laparoendoscopic single-site management of distal ureter during laparoscopic radical nephroureterectomy (Abstract Objective: To describe the management of the distal ureter during radical nephroureterectomy with T-LESS approach.Methods: Between January 2010 and October 2013, five patients underwent LRNU for upper urinary tract carcinoma with T-LESS approach. Patients were placed in supine position. A 2.5 cm skin incision was made in the line between the pubis and the umbilicus.The bladder identified and a multiport was inserted into the bladder. The patients were repositioned to a lateral decubitus position, pneumovesicum was established and the ureteral openings were identified.We marked the bladder cuff with electrocautery all the way through to the extravesical fat.The bladder defect was sealed with suture. After checking for any leak or bleeding, the multiport was removed and the bladder was closed. At this point we continued with nephrectomy by standard laparoscopy or LESS. A 18 French Foley catheter was placed into the bladder.Results: The mean age was 70 years (range 58 years to 81 years), mean operative time was 198 minutes (range 115 min to 390 min), the mean time for the management of the distal ureter was 35 minutes (range 27 min to 45 min), mean estimated blood loss was 234 cc (range 60 cc to 850 cc), mean hospital stay was 3,8 days (range 2 days to 8 days). In all patients the bladder cuff was free of disease.Conclusion: The transvesical laparoendoscopic single site approach to the distal ureter for upper urinary tract carcinoma appears safe and reproducible, with faster closure of the bladder defect and improved cosmesis.

A Novel and Simple Modification for Management of Distal Ureter During Laparoscopic Nephroureterectomy Without Patient Repositioning: A Bulldog Clamp Technique and Description of Modified Port Placement

“…The main disadvantage of this approach is the possibility of port-site metastases, which may be caused by urine extravasation with tumor cells through the bladder wall defect. In addition, this method is technically difficult with a steep learning curve 23,24 . In summary, none of these four techniques are purely laparoscopic, resulting in the requirement of patient repositioning or the risk of urethral complication due to the use This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction.…”

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

“…Circumscribing ureteral orifice and mobilizing ureter using fine 3-mm endoscopic scissors, and the defect of the bladder were sutured intravesically using 5-zero absorbable monofilament sutures. Nunez Bragayrac et al 14 used a laparoendoscopic single port transvesical approach with pneumovesicum to create a working space to manage the distal ureter, followed by the nephrectomy and caudal dissection. This technique provided good control of the distal ureter, minimized the potential for tumor seeding.…”