Initial Experience of Laparoendoscopic Single-site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Urothelial Carcinoma Performed by a Single Surgeon

Abstract

Purpose:

To present our experience with the first 10 consecutive cases of laparoendoscopic single-site nephroureterectomy (LESSNU) with bladder cuff excision for upper tract urothelial carcinoma.

Patients and Methods:

Ten patients (6 men and 4 women; 6 renal pelvis and 4 ureter) underwent LESSNU by a single surgeon. We made a 4-cm single incision at the umbilicus using a homemade single-port device. The single-port device was made with a surgical glove and Alexis wound retractor. LESSNU was performed by the same technique of conventional laparoscopic NU.

Results:

The mean age was 62.79±7.93 years. The mean total operative time, time for nephrectomy, and time for bladder cuff excision were 225.63±65.87, 80.00±29.03, and 145.63±42.63 minutes. The mean estimated blood loss was 187.50±83.45 mL. On surgical pathologic examination, four patients were pT₁N₀, four patients were pT₂N₀, one patient was pT₃N₀, and one patient was pT₃N₂. There was one positive surgical margin in a pT₃N₂ patient. The mean number of lymph nodes dissected was 2.5 (range 0–9). One incision extension was performed because of complete renal hilar lymphadenectomy by open technique (for the pT₃N₂ patient), and one open conversion with a Gibson incision was performed because of severe adhesions around the distal ureter (the pT₃N₀ patient). There were one case of transient ileus and one of fever that were improved with conservative treatment. The mean hospital stay was 4.75±3.37 days. Eight patients who underwent LESSNU successfully were satisfied with their operations.

Conclusions:

LESSNU for upper urinary tract urothelial carcinoma seems to be feasible and safe, but it is still challenging for advanced cases.