Hand-Assisted Retroperitoneoscopic Nephroureterectomy for Upper Urinary-Tract Urothelial Tumors

Abstract

Purpose

: We report our experience with hand-assisted retroperitoneoscopic nephroureterectomy for upper urinary-tract urothelial cancer.

Patients and Methods

: Our initial 10 cases of clinical stage T₁N₀M₀ renal pelvic and ureteral tumors treated with hand-assisted retroperitoneoscopic nephroureterectomy are included in the present report. Nephrectomy was conducted retroperitoneoscopically with hand assistance via a lower-abdominal midline incision. Resection of the lower ureter together with the bladder cuff was performed as open surgery and the specimen was removed en bloc via the same incision.

Results

: Hand-assisted retroperitoneoscopic nephroureterectomy was completed successfully in all 10 cases. The mean operating time was 456 ± 90 minutes, and the mean estimated blood loss was 462 ± 364 mL. The times to oral intake and walking were 1.5 ± 0.5 days and 2.3 ± 0.7 days, respectively. One case of renal vein injury, one case of pulmonary embolism, and three cases of wound infection were the complications.

Conclusion

: This is the first report of hand-assisted endoscopic nephroureterectomy using the retroperitoneal approach. The surgical technique seems quite reasonable because the lower-abdominal incision can be utilized, not only as a route for hand assistance, but also as a window for open surgery when resecting the distal ureter as well as for extracting the surgical specimen.