title: Antegrade mini-invasive nephroureterectomy: laparoscopic nephrectomy, transurethral excision of ureterovesical junction and lower abdominal incision.
abstract: BACKGROUND
  We describe another variant of nephroureterectomy - antegrade mini-invasive nephroureterectomy (AMNUE).
  
  
  METHODS
  AMNUE starts with a laparoscopic nephrectomy in the flank position. The specimen is enclosed in a bag without dividing the ureter, and the patient is positioned to the lithotomy position. Then the ureterovesical junction is excised transurethrally with a Collins knife. Finally, the specimen is removed and the ureter is plucked out through a short lower abdomen incision.
  
  
  METHODS
  From March 2005 to November 2008, 35 patients underwent nephroureterectomy: 7 as an open procedure, 8 as a laparoscopic nephrectomy with open ureterectomy, 8 as a complete laparoscopic nephroureterectomy, and 12 were admitted into the AMNUE group (7 men and 5 women, mean age 71 +/- 7 years, range 54-81 years).
  
  
  RESULTS
  Tumors were found 6 times on both sides. The mean operation time was 165 +/- 32 min (105-210 min), and the mean blood loss was 150 +/- 91 ml (50-400 ml). Histology revealed 11 urothelial cancers and 1 papillary renal cell carcinoma. There was only 1 hematoma of the abdominal wall.
  
  
  CONCLUSIONS
  AMNUE is a fast, safe and easily reproducible technique. It eliminates the risk of spillage of tumorous cells into the urine, which is possible in techniques where the ureter is excised with a Collins knife as the first procedure. The disadvantages of this approach are the necessary repositioning of the patient and that the long-term oncological results are currently unknown. AMNUE can be used when a complete laparoscopic nephroureterectomy is not technically feasible due to problems in the pelvis.
authors.affiliation: Department of Urology, Charles University Hospital, Plzen, Czech Republic. horam@fnplzen.cz
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.forename: Viktor
authors.initials: V
authors.lastname: Eret
authors.forename: Tomás
authors.initials: T
authors.lastname: Urge
authors.forename: Jirí
authors.initials: J
authors.lastname: Klecka
authors.forename: Petra
authors.initials: P
authors.lastname: Kocovská
authors.forename: Stránský
authors.initials: S
authors.lastname: Petr
authors.forename: Ondrej
authors.initials: O
authors.lastname: Hes
authors.forename: Jirí
authors.initials: J
authors.lastname: Ferda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*; D014521:Urethra; D001743:Urinary Bladder / Q000601:surgery*