Hand-assisted retroperitoneoscopic nephroureterectomy with bladder cuffing after preperitoneal and retroperitoneal perivesical ballooning.
OBJECTIVE
We aimed to describe the surgical technique of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) with bladder cuffing after preperitoneal and retroperitoneal perivesical ballooning.


METHODS
From March 2008 to September 2012, we performed HARNU and open bladder cuffing in 28 consecutive series of patients with upper urinary tract urothelial carcinoma. We performed HARNU according to the following procedure: (1) a camera port incision was made on the posterior axillary line; (2) multiple, repeated, preperitoneal and retroperitoneal ballooning was performed on both the posterior axillary line and in the umbilicus; (3) a 7.0 cm skin incision was made from the suprapubic to the lower inguinal with the balloon present in the extraperitoneal area; (4) hand-assisted laparoscopic retroperitoneal nephroureterectomy; (5) cessation of gas insufflation; and (6) extravesical cuffing as an open surgical procedure.


RESULTS
The mean estimated blood loss was 250 mL. The mean operation time was 240 minutes. The mean time to oral intake and ambulation was 1.0 day and two days, respectively. As for postoperative complications due to the hand-assisted device, one patient developed febrile urinary tract infection within three weeks postoperatively and was hospitalized again to receive parenteral antibiotics.


CONCLUSIONS
We made a low Gibson incision for a route for the hand-assisted procedure as well as a window for open surgery in dissecting the distal ureter and extracting the surgical specimens. Thus, our results indicate that the HARNU might be a feasible surgical modality.
Department of Urology, Gachon University Gil Medical Center, Incheon, Korea.
Chang Hee
CH
Kim
Department of Urology, Gachon University Gil Medical Center, Incheon, Korea.
Kwang Taek
KT
Kim
Department of Urology, Gachon University Gil Medical Center, Incheon, Korea.
Khae Hawn
KH
Kim
Department of Urology, Gachon University Gil Medical Center, Incheon, Korea.
Sang Jin
SJ
Yoon
Endoscopy; Hand-assisted laparoscopy; Nephrectomy; Transitional cell carcinoma; Ureteral neoplasms