Laparoscopic Nephroureterectomy: Initial Clinical Case Report

Clayman, Ralph V.; Kavoussi, Louis R.; Figenshau, Robert S.; Chandhoke, Paramjit S.; Albala, David

doi:10.1089/lps.1991.1.343

Cited by 351 publications

(143 citation statements)

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“…In the early 1990s, LNU was introduced. 21 Compared to open nephroureterectomy, the LNU procedure is associated with fewer morbidities, shorter convalescence period, 3 and comparable cancer control outcomes, 22 which has rendered the approach the preferred treatment by many academic hospitals with high volume. 3 In the last 10 years, robotic surgery has emerged as an alternative minimally invasive surgical treatment for many malignancies, including urological cancers.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Trudeau

Gandaglia

Shiffmann

et al. 2014

CUAJ

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Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large populationbased cohort of patients with upper-tract urothelial carcinoma (UTUC). Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU. IntroductionUpper-tract urothelial carcinoma (UTUC) accounts for about 5% of all urothelial carcinomas.1 According to treatment guidelines, radical nephroureterectomy (RNU) represents the treatment of choice for localized disease.2 Based on equal efficacy and easier convalescence compared to the open procedure, many urologists have advocated minimally invasive approaches as the standard of care. 2,3 In this context, laparoscopic nephroureterectomy (LNU) and robotic-assisted nephroureterectomy (RANU) are available; the robotic approach is being increasingly adopted for several other urologic malignancies.4 That being said, there is little data evaluating the safety and feasibility of RANU.5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population. Specifically, we focused on perioperative complications, blood transfusions, prolonged length of stay, in-hospital mortality and hospitalization costs. (NIS) database were abstracted. The NIS is a 20% stratified probability sample that encompasses about 8 million ...

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Section: Discussionmentioning

confidence: 99%

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Trudeau

Gandaglia

Shiffmann

et al. 2014

CUAJ

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“…In 1991, Clayman firstly described the technique of LNU as a treatment option for upper tract transitional cell carcinoma [1]. Laparoscopic surgery has found wide acceptance…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Nephroureterectomy for Upper Tract Transitional Cell Carcinoma: Comparison of Laparoscopic and Open Surgery

et al. 2006

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“…Accordingly, laparoscopic nephroureterectomy techniques (transperitoneal or retroperitoneal) have been developed to treat upper urinary tract TCC and are in clinical use worldwide. In 1991, Clayman and colleagues 2 reported the first laparoscopic nephroureterectomy; since then, several reports have been published that demonstrate superior short-term results and comparable oncologic outcomes of this procedure, as compared to open surgery. 3,4 Unfortunately, no randomized trials have been carried out to date and comparisons of the open and laparoscopic procedures are limited by differences in patient selection.…”

Section: Introductionmentioning

confidence: 99%

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

Wang¹,

Jiang²,

Chen³

et al. 2013

CUAJ

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Objective: We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). Methods: Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. Results: The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3-57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrencefree survival. Conclusion:The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy.

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Laparoscopic Nephroureterectomy: Initial Clinical Case Report

Abstract: Using a 12-mm GIA laparoscopic stapling device, a method of organ entrapment, and a recently developed high-speed electrical tissue morcellator, laparoscopic nephroureterectomy was accomplished in an 82-year-old male with a low-grade transitional cell cancer of the renal pelvis.

Cited by 351 publications

References 10 publications

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Laparoscopic Nephroureterectomy for Upper Tract Transitional Cell Carcinoma: Comparison of Laparoscopic and Open Surgery

Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

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