Abstract：Objective:To evaluate the feasibility, safety and effectiveness of purely laparoscopic nephroureterectomy in the treatment of ureteric tumors on the lower segment.Methods:Between January 2012 and December 2012, 7 patients with lower urinary transitional cell carcinoma(TCC) underwent nephroureterectomy with purely laparoscopic approach. A standard retroperitoneal laparoscopic nephrectomy was performed firstly. Then the line of Toldt was opened from the retroperitoneal approach,the patients were changed to a position of 30 degree supine, under the guide of the previous retroperitoneal camera through the 12mm trocar inferior to the 12th rib tip, the left two trocars of tansperitoneal approach were placed. The dissection of distal ureter was carried out in a transperitoneal approach. The detrusor muscle was sharply incised and further dissected away from the underneath bladder mucosa with 1 cm around the normal tissue of ureteral orifice. The bladder was closed with single layer running suture. An indwelling 18F Foley catheter is then placed. 3 patients were arrange to undergo the partial cystectomy in a standard transperitoneal approach, as the ureteric distal tumor have invaded the bladder to some distance. Prior to the intervention the vesical perfusion was undertook in these 3 cases. One patient is un-operative due to the severe adhesion. One patient underwent the ipsilateral lymphadenectomy with an advanced tumor.Results:The mean time of operation was 126(86-160) mins. The mean blood loss was 112(20-200) ml. The histology was 7 urothelial cancer (1 csae pT3, 3 cases pT2, 3 cases pT1). Complications were naught. All patients were discharged from hospital on 6(5-8) days. One patient was un-operative due to the severe adhesion and merely underwent the simple nephrectomy. The mean follow-up is 6 (1-10) months. There is no recurrent of tumors locally and in bladder. The patient who was un-operative died of lung metastasis 4 months later postoperatively.Conclusions:The described procedure adheres strictly to oncologic principles, it could be considered a valid option for the treatment of lower urinary tract TCC. A longer follow-up period is necessary to verify its oncological outcomes.
马鑫, 刘启明, 俞鸿凯, 张旭. 全腹腔镜下肾输尿管全长切除治疗输尿管下段肿瘤的初步经验(附7例报告)[J]. 微创泌尿外科杂志, 2013, 2(3): 174-176.
Ma Xin, Liu Qiming, Yu Hongkai, Zhang Xu. Purely laparoscopic nephroureterectomy in the treatment of ureteric tumors on the lower segment. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2013, 2(3): 174-176.
[1]Clayman RV, Kavoussi LR, Figenshau RS, et al. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg, 1991,1(6):343-349. [2]Horal M, Eretl E.Complete laparoscopic nephro-ureterectomy. Eau 9th central european meeting (cem). Eur Urol Suppl, 2009,8(8): 657-702. [3]Favaretto RL, Shariat SF, Chade DC, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol, 2010, 58(5):645-651. [4]Kamihira O, Hattori R, Yamaguchi A, et al. Laparoscopic radical nephroureterectomy: a multicenter analysis in Japan. Eur Urol, 2009,55(6):1397-1407. [5]Kuczyk MA, Sturm W, Stenzl A, et al. Critical Considerations regarding Laparoscopic Nephroureterectomy for the Treatment of Upper Urinary Tract Carcinoma. Eur Urol Suppl, 2007,6(8): 555-559. [6]Robson CJ. Radical nephrectomyfor renal cell carcinoma. J Urol, 1963,89(1):37-42. [7]Klingler HC, Lodde M, Pycha A, et al. Modified laparoscopic nephroureterectomy for treatment of upper urinary tract transitional cell cancer is not associated with an increased risk of tumour recurrence. Eur Urol, 2003,44(4):442-447. [8]Rassweiler JJ, Schulze M, Marrero R, et al. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery?Eur Urol,2004,46(6):690-697. [9]Laguna MP, de la Rosette JJ. The endoscopic approach to the distal ureter in nephroureterectomy for upper urinary tract tumor.J Urol, 2001,166(6):2017-2022. [10]Tsivian A, Benjamin S, Sidi AA. A sealed laparoscopic nephroureterectomy: a new technique.Eur Urol,2007,52(4):1015-1059.
