title: A one-port pneumovesicum method in en bloc laparoscopic nephroureterectomy with bladder cuff resection is feasible and safe for upper tract transitional cell carcinoma.
abstract: OBJECTIVE
  • To introduce a modified method for managing the distal ureter in laparoscopic nephroureterectomy (LNU) for upper tract transitional cell carcinoma (TCC) and to evaluate the feasibility and safety of this method.
  
  
  METHODS
  • Six consecutive patients underwent LNU using a one-port pneumovesicum method for pathologically confirmed upper tract TCC. • Each patient was placed on the operating table in the lithotomy position and the pneumovesicum method was applied with CO(2) insufflation. Dissection was performed circumferentially through the entire detrusor muscle to disconnect the ureter from the bladder wall. A 10-mm trocar was placed into the bladder above the pubic bone. The distal ureter was occluded using a Hem-o-lok clip and pushed out of the bladder. Laparoscopic nephroureterectomy was then performed with the patient in the lateral position. • After surgery, all six patients received systemic chemotherapy and follow-up.
  
  
  RESULTS
  • All procedures were performed successfully. • The median (range) operating time for the complete procedure was 105 (85-140) min, and the median (range) estimated blood loss was 125 (60-230) mL. • Seven days after surgery, each patient underwent cystography, which confirmed no extravasation of urine. • None of the patients developed bladder tumour recurrence or metastatic disease during follow-up.
  
  
  CONCLUSIONS
  • The one-port pneumovesicum method in LNU, which is applied to manage the distal ureter and bladder cuff, is technically feasible and safe. • The method simplifies management of the distal ureter, reduces the invasiveness of the procedure and improves cosmesis.
authors.affiliation: Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China. gyfyurology@126.com
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Zou
authors.forename: Guoxi
authors.initials: G
authors.lastname: Zhang
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Wang
authors.forename: Yuanhu
authors.initials: Y
authors.lastname: Yuan
authors.forename: Rihai
authors.initials: R
authors.lastname: Xiao
authors.forename: Gengqing
authors.initials: G
authors.lastname: Wu
authors.forename: Dazhi
authors.initials: D
authors.lastname: Long
authors.forename: Hui
authors.initials: H
authors.lastname: Xu
authors.forename: Yuting
authors.initials: Y
authors.lastname: Wu
authors.forename: Folin
authors.initials: F
authors.lastname: Liu
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*