title: Hand assisted retroperitoneoscopic nephroureterectomy with the patient spread-eagled: an approach through a completely supine position.
abstract: OBJECTIVE
  We evaluated the feasibility of hand assisted retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of the upper urinary tract with the patient completely supine (spread-eagled).
  
  
  METHODS
  From October 2006 to January 2008 hand assisted retroperitoneoscopic nephroureterectomy with open bladder cuff excision was performed in 32 patients with upper tract transitional cell carcinoma. The patient was placed supine with the legs extended and abducted at 45 to 60 degrees, and the arms stretched out to the sides in the spread-eagle position. The patient was secured to the operation table with 3-inch tapes to permit lateral table tilt. The operation was completed via a 7 or 8 cm Gibson incision plus 2 laparoscopic ports.
  
  
  RESULTS
  All procedures were successful. The mean time needed for hand assisted retroperitoneoscopic nephroureterectomy and bladder cuff resection was 137.6 minutes. Mean estimated blood loss was 200 ml. Simultaneous transurethral endoscopic procedures were performed in 8 patients. Time to oral intake was 2.1 days and time to ambulation was 2.0 days. No specific complication was related to the position. All patients recovered to normal daily activity uneventfully.
  
  
  CONCLUSIONS
  Hand assisted retroperitoneoscopic nephroureterectomy with the patient completely supine is feasible and safe. The completely supine position has several advantages, including ease of patient positioning and the ability to perform simultaneous endoscopic procedures. It not only decreases the time and cost of changing position, but also avoids potential risks associated with the lateral decubitus position. Bowel interference with the visual field and mechanical bowel injury are not a concern using this approach.
authors.affiliation: Department of Urology, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan, Republic of China.
authors.forename: Chien-Hui
authors.initials: CH
authors.lastname: Ou
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D011028:Pneumoperitoneum, Artificial; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D018570:Risk Assessment; D016683:Supine Position; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*