Supine extraperitoneal laparoscopic nephroureterectomy without patient repositioning.
bladder cuff excision
lymphadenectomy
nephroureterectomy
upper urinary tract urothelial carcinoma
Journal
International journal of urology : official journal of the Japanese Urological Association
ISSN: 1442-2042
Titre abrégé: Int J Urol
Pays: Australia
ID NLM: 9440237
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
25
07
2020
accepted:
30
09
2020
pubmed:
17
11
2020
medline:
28
4
2021
entrez:
16
11
2020
Statut:
ppublish
Résumé
To describe a novel technique allowing laparoscopic nephroureterectomy with bladder cuff excision and lymphadenectomy, in a complete supine position, without patient repositioning. Between January 2016 and October 2018, 20 consecutive patients with upper urinary tract urothelial carcinoma underwent supine extraperitoneal laparoscopic nephroureterectomy. The patients were placed in the complete supine position. A 4-cm pararectal skin incision was made and the extraperitoneal space was developed. We used a unique port placement that permits complete access for nephroureterectomy, bladder cuff excision and concomitant lymphadenectomy. Operative parameters and pathological data were analyzed. The median age was 70 years (range 49-88 years), the mean operative time was 234 min (range 175-293 min) and the mean estimated blood loss was 67 mL (range 50-200 mL). There were no intraoperative complications, and no patients required transfusion or open conversion. The median number of removed lymph nodes was 10; only one patient had node metastasis. The total operative time and time for nephroureterectomy were significantly longer in the first 10 patients (first group) than in the second 10 patients (second group). Times required for bladder cuff excision and lymphadenectomy did not differ between the two groups. Our novel technique, which enables completion of the entire procedure of nephrouretectomy with bladder cuff excision and lymphadenectomy in the supine position without patient repositioning, is safe and minimizes operative time while maintaining oncological efficacy. We believe this approach might become a standard option for patients with upper urinary tract urothelial carcinoma.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
163-168Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The Japanese Urological Association.
Références
Greco F, Wagner S, Hoda RM, Hamza A, Fornara P. Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up. BJU Int. 2009; 104: 1274-8.
Ni S, Tao W, Chen Q et al. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur. Urol. 2012; 61: 1142-53.
Hu JC, Silletti JP, Williams SB. Initial experience with robot-assisted minimally-invasive nephroureterectomy. J. Endourol. 2008; 22: 699-704.
Aboumohamed AA, Krane LS, Hemal AK. Oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma. J. Urol. 2015; 194: 1561-6.
Badani KK, Rothberg MB, Bergman A et al. Robot-assisted nephroureterectomy and bladder cuff excision without patient or robot repositioning: description of modified port placement and technique. J. Laparoendosc. Adv. Surg. Tech. A 2014; 24: 647-50.
Hattori R, Yoshino Y, Komatsu T, Matsukawa Y, Ono Y, Gotoh M. Pure laparoscopic complete excision of distal ureter with a bladder cuff for upper tract urothelial carcinoma. World J. Urol. 2009; 27: 253-8.
Ou CH, Yang WH, Tzai TS, Tong YC, Chang CC, Lin YM. A modified supine position to speed hand assisted retroperitoneoscopic nephroureterectomy: the Johnnie Walker position. J. Urol. 2006; 176: 2063-7.
Ou CH, Yang WH. Hand assisted retroperitoneoscopic nephroureterectomy with the patient spread-eagled: an approach through a completely supine position. J. Urol. 2008; 180: 1918-22.
Park SY, Jeong W, Ham WS, Kim WT, Rha KH. Initial experience of robotic nephroureterectomy: a hybrid-port technique. BJU Int. 2009; 104: 1718-21.
Hemal AK, Stansel I, Babbar P, Patel M. Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology 2011; 78: 357-64.
Lee JY, Kim SJ, Moon HS, Kim YT, Lee TY, Park SY. Initial experience of laparoendoscopic single-site nephroureterectomy with bladder cuff excision for upper urinary tract urothelial carcinoma performed by a single surgeon. J. Eendourol. 2011; 25: 1763-8.
Lee Z, Cadillo-Chavez R, Lee DI, Llukani E, Eun D. The technique of single stage pure robotic nephroureterectomy. J. Eendourol. 2013; 27: 189-95.
Zargar H, Krishnan J, Autorino R et al. Robotic nephroureterectomy: a simplified approach requiring no patient repositioning or robot redocking. Eur. Urol. 2014; 66: 769-77.
Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J. Urol. 2007; 178: 1212-7.
Kondo T, Tanabe K. Role of lymphadenectomy in the management of urothelial carcinoma of the bladder and the upper urinary tract. Int. J. Urol. 2012; 19: 710-21.
Roscigno M, Shariat SF, Margulis V et al. Impact of lymph node dissection on cancer specific survival in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. J. Urol. 2009; 181: 2482-9.
Mason RJ, Kassouf W, Bell DG et al. The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience. Urology 2012; 79: 840-5.
Kanno T, Kobori G, Kubota M et al. Standardized and simplified retroperitoneal lymph node dissection during retroperitoneal laparoscopic radical nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis: en bloc resection technique. Urology 2018; 112: 85-91.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205-13.
Phe V, Cussenot O, Bitker MO, Roupret M. Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy? BJU Int. 2011; 108: 130-8.
Ghazi A, Shefler A, Gruell M, Zimmermann R, Janetschek G. A novel approach for a complete laparoscopic nephroureterectomy with bladder cuff excision. J. Endourol. 2010; 24: 415-9.
Shoma AM. Purse-string technique for laparoscopic excision of a bladder mucosal cuff in patients with transitional cell carcinoma of the upper urinary tract: initial report with intermediate follow-up. BJU Int. 2009; 104: 1505-9.
Li P, Tao J, Deng X et al. Extraperitoneal laparoscopic radical nephroureterectomy and lymph node dissection in modified supine position. Urology 2017; 107: 126-31.
Inokuchi J, Kuroiwa K, Kakehi Y et al. Role of lymph node dissection during radical nephroureterectomy for upper urinary tract urothelial cancer: multi-institutional large retrospective study JCOG1110A. World J. Urol. 2017; 35: 1737-44.
LeBlanc E, Caty A, Dargent D, Querleu D, Mazeman E. Extraperitoneal laparoscopic para-aortic lymph node dissection for early stage nonseminomatous germ cell tumors of the testis with introduction of a nerve sparing technique: description and results. J. Urol. 2001; 165: 89-92.
Roscigno M, Shariat SF, Margulis V et al. The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed? Eur. Urol. 2009; 56: 512-8.