title: Retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the renal pelvis and ureter: Nagoya experience.
abstract: OBJECTIVE
  To evaluate the efficacy of our new retroperitoneoscopic nephroureterectomy for patients with transitional cell carcinoma of the renal pelvis and ureter, we present the operative procedure and analysis of the clinical outcome of retroperitoneoscopy in 23 patients.
  
  
  METHODS
  Twenty-three patients with transitional cell carcinoma of the upper urinary tract underwent retroperitoneal laparoscopic nephroureterectomy between February 2000 and February 2002. Patient age ranged from 44 to 83 years (mean 66.7). Each kidney was retroperitoneoscopically dissected en bloc, together with the perirenal fatty tissue, lymph nodes, and/or adrenal gland, without transecting the ureter. The lower ureter was resected with the bladder cuff transected using an ultrasonic scalpel and an endoscopic gastrointestinal automatic stapler. The dissected specimen was removed intact through a 6-cm-long original incision.
  
  
  RESULTS
  The mean operating time was 4.8 hours, including 0.7 hours for complete removal of the ureteral end with the bladder cuff. The mean estimated blood loss was 304 mL. The mean time to recovery to normal activity was 18 days. In the mean follow-up period of 15 months, 2 patients died of cancer progression in the sixth postoperative month, 2 died of other causes, and 4 had recurrent transitional cell carcinoma of the bladder after surgery.
  
  
  CONCLUSIONS
  Our retroperitoneal laparoscopic nephroureterectomy using an endoscopic gastrointestinal automatic stapler is a fast, low-risk, and minimally invasive procedure and might be an alternative to other laparoscopic techniques and open nephroureterectomy. However, long-term follow-up is necessary to confirm the efficacy for patients with transitional cell carcinoma of the renal pelvis and ureter.
authors.affiliation: Department of Urology, Nagoya University School of Medicine, Nagoya-shi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshino
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ono
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Osamu
authors.initials: O
authors.lastname: Kamihira
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ohshima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D007682:Kidney Pelvis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D013528:Surgical Staplers; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery; D018666:Ureteroscopy / Q000379:methods; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*