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A Sealed Laparoscopic Nephroureterectomy: A New Technique

2006; Elsevier BV; Volume: 52; Issue: 4 Linguagem: Inglês

10.1016/j.eururo.2006.10.036

1873-7560

Alexander Tsivian, Shalva Benjamin, A. Sidi,

Pediatric Urology and Nephrology Studies

To describe a purely laparoscopic nephroureterectomy approach that avoids the disadvantages of transurethral bladder cuff excision and open/laparoscopic distal ureterectomy using the EndoGIA. A standard transperitoneal laparoscopic nephrectomy is carried out through three or four ports in the flank. The ureter is dissected caudally into the pelvis. Two additional (5- and 10-mm) trocars are placed in the ipsilateral lower abdomen. Caudal ureteral dissection continues until the detrusor muscle fibers at the ureterovesical junction are identified. A 1-cm area of bladder adventitia around the ureterovesical junction is cleared. The ureter is retracted upward and laterally, tenting up the bladder wall. The bladder cuff is excised using a 10-mm LigaSure Atlas and detached from the bladder. A 6-cm lower-quadrant incision is used to remove the specimen in an Endocatch bag. An indwelling 16F Foley catheter is then placed. Thirteen adult patients with suspected upper-tract transitional cell carcinoma underwent this surgical technique (operative time: 170–270 min): none had local recurrence, and two had recurrence remote from the bladder cuff scar (follow-up: 1–23 months). The described procedure adheres strictly to oncologic principles (removal of the affected renal unit without opening the urinary tract), and circumvents the need for transurethral/intraureteral instrumentation and patient repositioning.