Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter

Kaouk, Jihad; Savage, Stephen J.; Gill, Inderbir S.

doi:10.1089/089277901300189394

Cited by 20 publications

(12 citation statements)

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“…Por consiguiente, se pone clip en el uréter distal para impedir su migración y movilizar el uréter 6 . Existen dos abordajes alternativos para la retirada endoscópica del uréter distal y del manguito vesical sin necesidad de cambiar al paciente de posición 13,[19][20][21][22][23][24][25][26] . En ambos méto-dos se realiza nefrectomía laparoscópica asistida por mano previa a la excisión del uréter distal con el manguito vesical.…”

Section: Discussionunclassified

Nueva técnica para la ureterectomía distal y excisión de manguito vesical

et al. 2011

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ResumenIntroducción: Se describe un novedoso abordaje endoscópico y se hace una revisión de la literatura para la disección «en bloque» del uréter distal y el manguito vesical durante la nefroureterectomía radical laparoscópica, usando un puerto único multicanal transvesical con pneumovejiga (pneumovesicum). Materiales y método: El procedimiento se llevó a cabo en un hombre de 80 años de edad, con historia de hematuria macroscópica debida a carcinoma de células transicionales (CCT) en la pelvis renal izquierda, sin historia previa de CCT en vejiga. Se realizó una nefroureterectomía radical laparoscópica y el uréter fue disecado hasta la inserción en la vejiga y fue clipado. Un dispositivo de puerto único multicanal (single-port) fue insertado transvesicalmente y se estableció la pneumovejiga. Se practica una incisión de la vejiga en todo su grosor alrededor del uréter, y se va realizando una movilización intravesical del uréter distal. Subsecuentemente, se realiza un cierre hermético del defecto vesical. El uréter distal, junto con el manguito vesical, se liberan laparoscópicamente y se extraen en bloque con el espécimen. Resultados: El tiempo operatorio (nefroureterectomía radical laparoscópica, LDRP y escisión del manguito vesical por puerto único) fue de 6 horas y 15 minutos. El tiempo del manguito vesical fue de 45 minutos. No hubo complicaciones intra o postoperatorias y la sonda fue retirada al sexto día de la cirugía. El análisis histopatológico mostró CCT comprometiendo el riñón, pT3G3 pN0 (0/7). Conclusión: La técnica de abordaje del uréter distal y el manguito vesical aún no ha sido estandarizada. El manejo del manguito vesical con un puerto único multicanal es factible. Estudios adicionales son necesarios para identificar cuál es el mejor abordaje para el manejo del uréter distal durante una nefroureterectomía laparoscópica.

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Section: Discussionunclassified

Nueva técnica para la ureterectomía distal y excisión de manguito vesical

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“…Furthermore, utilizing the pluck technique is likely to permit continued urine extravasation from the cancer-bearing ureter [24, 25]. Additionally, due to the absence of an identifiable marker within the detached distal ureter, confirmation of complete specimen removal is not possible, raising the theoretical possibility of local recurrence in any remaining portion of ureter [24].…”

Section: Transurethral Resection Of Ureteral Orifice (“Pluck” Techmentioning

confidence: 99%

“…Additionally, due to the absence of an identifiable marker within the detached distal ureter, confirmation of complete specimen removal is not possible, raising the theoretical possibility of local recurrence in any remaining portion of ureter [24]. …”

Section: Transurethral Resection Of Ureteral Orifice (“Pluck” Techmentioning

confidence: 99%

“…Complete retrieval is confirmed by visualization of the Endoloop. However, this may be a difficult technique to master for most urologists and operating time is usually lengthened by 60–90 minutes [24, 47]. Other criticism of this approach includes the potential for irrigation fluid extravasation resulting in dilutional hyponatremia, the need for patient repositioning, and the possibility of port-site metastases.…”

Section: Pure Laparoscopicmentioning

confidence: 99%

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Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

Srirangam

Cleynenbreugel

Poppel

2009

Advances in Urology

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Transitional cell carcinoma affecting the upper urinary tract, though uncommon, constitutes a serious urologic disease. Radical nephroureterectomy remains the treatment of choice but has undergone numerous modifications over the years. Although the standard technique has not been defined, the laparoscopic approach has gained in popularity in the last two decades. The most appropriate oncological management of the distal ureteral and bladder cuff has been a subject of much debate. The aim of the nephroureterectomy procedure is to remove the entire ipsilateral upper tract in continuity while avoiding extravesical transfer of tumor-containing urine during bladder surgery. A myriad of technical modifications have been described. In this article, we review the literature and present an overview of the options for dealing with the lower ureter during radical nephroureterectomy.

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“…Gill and the Cleveland Clinic group summarize the overall laparoscopic approach to nephroureterectomy. 2 There is also a discussion of different approaches, including retroperitoneal and transperitoneal. In some of the earlier series, the operative time was very long, as described by other groups.…”

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confidence: 99%

Editorial Comment: Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter

Marshall¹

2001

Journal of Endourology

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management of transitional-cell carcinoma (TCC) of the renal pelvis. Dr. Arthur D. Smith and his group have been among the pioneers in the percutaneous and endoscopic approach to the treatment of upper tract TCC. 1 Improved instrumentation has greatly facilitated the biopsy and destruction of small ureteral tumors. The 7.5F flexible ureteroscope and the laser help significantly. Endoluminal sonography can estimate the extent of intrarenal invasion. Grade 1 tumors have a favorable prognosis, with a low incidence of invasion. There is an increasing likelihood of invasion with grade 2 and, even more, with grade 3 TCC. Smith and his colleagues have had a favorable experience with topical chemotherapy. The use of BCG has a relatively how incidence of complications, but close attention to detail in the management of these patients is paramount.Dr. Gill and the Cleveland Clinic group summarize the overall laparoscopic approach to nephroureterectomy. 2 There is also a discussion of different approaches, including retroperitoneal and transperitoneal. In some of the earlier series, the operative time was very long, as described by other groups. Under typical circumstances, it would appear advisable to consider a retroperitoneal approach, as Drs. Kaouk, Savage, and Gill describe. They occlude and resect the ureter first. If there is a problem in that dissection or with the patient, the surgeon is clearly forced to proceed with nephrectomy if this approach has been elected. Occlusion of the ureter will initially produce hemodynamic changes in the kidney if the time to nephrectomy is long. The advisability of the open hole in the bladder in the area of the dissected ureter can be debated. On the other hand, the operative time, blood loss, and hospital stay all compare favorably with those of open procedures at the same institution.Dr. Sosa and his group describe the use of hand-assisted techniques in the performance of a nephroureterectomy. 3 This technique represents an intermediate step between the open and laparoscopic techniques. A significant incision is generally required to remove the specimen intact, even when standard laparoscopic techniques are utilized. Whatever approach was employed, there were no open conversions. The medication use and operative time were not significantly different the hand-assisted and standard laparoscopy techniques. The hand-assisted technique will be more familiar to urologists.There are some other maneuvers, such as relying on ureteral intussusception, that may not work for everyone and could result in later bleeding. Two patients in the group at the Cleveland Clinic were later explored for hemorrhage, although these surgeons did not use the intussusception technique. A larger incision does need to be made at some point to remove the specimen.The authors of all of these papers should be congratulated for their pioneering work in the treatment of TCC of the upper urinary tract. The incisions for laparoscopic nephroureterectomy cause a smaller surgical insult than those needed for open opera...

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Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter

Cited by 20 publications

References 19 publications

Nueva técnica para la ureterectomía distal y excisión de manguito vesical

Nueva técnica para la ureterectomía distal y excisión de manguito vesical

Laparoscopic Nephroureterectomy: The Distal Ureteral Dilemma

Editorial Comment: Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter

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