Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Summary

Here, we present a protocol to increase the surgical field of view and reduce the difficulty of total transperitoneal laparoscopic nephroureterectomy surgery by precutting the umbilical ligament before treating the terminal ureter.

Abstract

Upper tract urothelial carcinoma (UTUC) accounts for 5%–10% of all urothelial tumors. Radical nephroureterectomy is the standard treatment procedure. At present, different choices still exist for treating the ureteral end during laparoscopic ureteral bladder sleeve resection. Our center has adopted a new method for treating the ureteral end. This new method can increase the operating space and reduce the difficulty of the surgery compared with current methods.

Introduction

Radical nephroureterectomy is a standard procedure for treating upper tract urothelial carcinoma (UTUC)¹. Traditional open surgery requires two large incisions in the lower abdomen, which is associated with a large amount of trauma and many complications². With the rapid development of minimally invasive techniques in urology, laparoscopic surgery has been gradually applied in many research studies. Laparoscopic surgery is identical to open surgery in treating the tumors, so the traditional surgical methods have gradually been replaced by laparoscopic surgery³.

In lapar....

Protocol

All methods described here have been approved by the ethics committee of the Beijing Hospital. Indications and contraindications for surgery are according to the European Association of Urology guidelines for upper urinary tract urothelial cell carcinoma.

1. Instruments for Operation

1. Ensure the availability of the laparoscopic imaging system, images of the pneumoperitoneum, and ultrasonic scalpel.

2. Preparation for Operation

1. Prepare the patient with a bowel cleansing before the operation. Have the anesthesiologist perform an anesthesia risk assessment of the patient prior to surger....

Results

In total, 87 patients underwent surgery without difficulties, and there were no open surgeries. The average age of the patients was 67.25 ± 9.90 years. Within this group, there were 47 cases of renal pelvic cancer, 10 cases of pelvic cancer with ureteral cancer, and 30 cases of ureteral cancer (10 cases of upper ureteral cancer, 9 cases of middle ureteral cancer, and 11 cases of lower ureteral cancer). In total, 49 cancers were on the left side and 38 cancers were on the right side. The average tumor diameter was 3.24 ± .......

Discussion

A traditional open renal ureter resection and bladder cuff-like resection mostly involve upper and lower incisions, which require changing positions and disinfecting the surgical towels twice. The operation time is long, and the amount of trauma is large. Laparoscopic renal ureter and bladder sleeve resection have been gradually adopted by urologists since minimally invasive surgery techniques have been widely used in urology⁸. The methods for laparoscopic nephroureterectomy and radical resection .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Laparoscopic imaging system	STORZ
Pneumoperitoneum	STORZ
Ultrasonic scalpel	Johnson
Vascular closure clip	Hem-o-Lock