A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes

Abstract

Background The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and to reported our early outcomes. Methods From January 2017 to October 2018, a total of 45 patients underwent LNU by a single surgeon at our department, of whom 25 patients underwent standard technique and 20 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results LNU was performed successfully on all 45 patients. There was no significant difference in patients' characteristics.Compared to standard group, patients in CRT group had shorter operative time, less estimated blood loss (EBL), lower visual analogue scale (VAS) pain score and less scar ( P <0.001). The mean time of surgical drain stay decreased from 4.2d to 2.8d and median hospital stay after surgery decreased from 5d to 3d ( P <0.001). The complication rates did not show statistic difference between the two groups within the first 30 days postoperatively ( P =0.258). For the long-term complications, the incidence of abdomen bulge or incisional hernia in CRT group was less than that in the standard group ( P <0.001). Conclusion The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.

A Modified Hybrid Operation:The Retroperitoneoscopic Nephroureterectomy Without Intraoperative Patient Repositioning

“…Even though various systemic treatments of UTUC occurred rencently, radical nephroureterectomy (RNU) with bladder cuff excision remains the gold standard for UTUC [4]. Surgical approaches for UTUC emerged one after another with the development of technology [5][6][7][8][9][10][11][12].…”