Laparoendoscopic Single-Site Nephroureterectomy and En Bloc Resection of Bladder Cuff with an Endoloop

Abstract

Introduction:

To present the initial experience of laparoendoscopic single-site (LESS) nephroureterectomy via the transperitoneal approach using a homemade single port and bladder-cuff resection by endoloop.

Materials and Methods:

LESS nephroureterectomy was performed with a homemade single port created using an Alexis wound retractor as an access platform through a 4-cm incision over umbilicus. ¹ This video included a brief presentation of a 57-year-old woman who presented with painless gross hematuria. An upper tract high-grade urothelial carcinoma was identified. The LESS nephroureterectomy and bladder-cuff resection were performed through the same incision over the umbilicus. The distal ureters were resected with an endoloop. ² The procedure was completed. No additional ports were used. The outside shots demonstrating the maneuvering the instruments were also included in our slides.

Results and Conclusions:

Between August 2009 and May 2010, we have performed LESS nephroureterectomy for five consecutive patients with upper tract urothelial carcinomas. The mean operative time was 284.0 ± 94.9 minutes. The mean estimated blood loss was 70.0 ± 24.5 mL. The mean hospital stay was 5.6 ± 3.5 days. Complete bladder-cuff resection was confirmed grossly in all cases. None of our cases had a urinary leakage, which was confirmed by cystography postoperatively. There is only one laparoscopic conversion caused by tight adhesions of renal hilum surroundings, which made progress difficult. There was no operation-related complication. Histopathologic examination demonstrated negative-resection margins in all cases. Our initial experience revealed that LESS nephroureterectomy and use of endoloop to complete bladder-cuff resection is a safe and feasible procedure for upper urinary tract urothelial carcinoma. Further prospective and long-term studies are warranted to provide more solid evidence with regard to perioperative benefits and oncologic control.

All authors have declared no conflicts of interest.

Runtime of video: 8 mins 45 secs