title: Single-session laparoscopic total urinary tract exenteration without repositioning for multifocal urothelial carcinoma in dialysis-dependent patients.
abstract: OBJECTIVE
  To report our experience of single-session, en bloc, laparoscopic total urinary tract exenteration in dialysis-dependent patients with multifocal urothelial carcinoma.
  
  
  METHODS
  From June 2005 to April 2008, 5 dialysis-dependent patients (4 women and 1 man) diagnosed with synchronous upper urinary tract and bladder urothelial carcinoma underwent single-session, en bloc, laparoscopic total urinary tract exenteration. Bilateral nephroureterectomy was facilitated by rotating the operating table with or without alternative inflation of the tourniquet cuffs on either side of the patient's back to allow adequate spontaneous bowel displacement by gravity, thereby avoiding the need to reposition the patient. After completing bilateral nephroureterectomy, we performed radical cystectomy with the patient in the Trendelenburg position. All specimens, including the 2 kidneys, ureters, and bladder, were collected in an endobag and were intended to be retrieved using the Pfannenstiel incision in male patients and the vaginal route in the female patients. The demographic and perioperative information were collected and analyzed.
  
  
  RESULTS
  All the laparoscopic procedures were completed successfully without major complications. Although 1 patient developed a minor complication owing to paralytic ileus, she recovered after conservative treatment. The continuity of all the urothelial epithelium was maintained intact throughout the procedure to avoid tumor spillage.
  
  
  CONCLUSIONS
  In our experience, laparoscopic total urinary tract exenteration is a technically feasible and safe alternative modality to the open counterpart to treat dialysis-dependent patients with end-stage renal disease with multifocal urothelial carcinoma for experienced surgeons with advanced laparoscopic skills. Furthermore, it can be performed successfully without the need for repositioning the patient, and this probably decreased the incidence of associated complication in the high-risk patients.
authors.affiliation: Department of Urology, E-Da Hospital, Kaohsiung County, Taiwan, Republic of China. victorlin0098@gmail.com
authors.forename: Victor Chia-Hsiang
authors.initials: VC
authors.lastname: Lin
authors.forename: Kuo-Chuan
authors.initials: KC
authors.lastname: Hung
authors.forename: Ming-Jenn
authors.initials: MJ
authors.lastname: Chen
authors.forename: Kevin
authors.initials: K
authors.lastname: Lu
authors.forename: Yuchi
authors.initials: Y
authors.lastname: Chen
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Weng
authors.forename: Tsan Jung
authors.initials: TJ
authors.lastname: Yu
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D010385:Pelvic Exenteration / Q000379:methods; D006435:Renal Dialysis; D014551:Urinary Tract / Q000601:surgery*; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods