title: Hand-assisted laparoscopic bladder cuff excision via the same hand port as that used for nephroureterectomy.
abstract: OBJECTIVE
  The aim of this study was to report our technique of hand-assisted laparoscopic bladder cuff excision through the same hand port as that used for nephroureterectomy and evaluate its benefits and short-term oncologic outcomes.
  
  
  METHODS
  We included 67 consecutive patients treated by a single surgeon between June 2011 and November 2014 with hand-assisted laparoscopic bladder cuff excision through the same hand port as that used for nephroureterectomy. We retrospectively analyzed procedure-related clinical data and short-term oncologic outcomes.
  
  
  RESULTS
  The mean patient age was 66.2 ± 10.6 years. The mean follow-up period was 17.6 months (range 1-37 months). The mean operation time was 243.5 ± 60.4 min. There were no major accidents or open conversions. Forty-two patients (63 %) underwent immediate mitomycin C instillation without complications. There was one high-grade complication (prolonged lymphatic leakage) that required reoperation and multiple hospitalizations. Thirty patients (45 %) underwent regional lymph node dissection. The pathological stages included CIS in 2 (3 %), Ta/T1 in 32 (48 %), T2 in 6 (9 %), T3 in 27 (40 %), and N+ in 4 (6 %) cases. G1, G2, and G3 were seen in 3 (5 %), 21 (31 %), and 43 (64 %) patients, respectively. Eighteen patients (26 %) underwent postoperative adjuvant chemotherapy. Two patients died during the study period, and nine patients (13 %) had bladder recurrences.
  
  
  CONCLUSIONS
  HAL bladder cuff excision through the same hand port used for nephroureterectomy is a feasible technique that is both amenable to oncologic principles and can reproduce the open surgical technique.
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.|Department of Urology, Kangwon National University Hospital, Chuncheon, Korea.
authors.forename: Geehyun
authors.initials: G
authors.lastname: Song
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Kyung-Sik
authors.initials: KS
authors.lastname: Han
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Song
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Myung-Soo
authors.initials: MS
authors.lastname: Choo
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Hanjong
authors.initials: H
authors.lastname: Ahn
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. bshong@amc.seoul.kr.
authors.forename: Bumsik
authors.initials: B
authors.lastname: Hong
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D058733:Hand-Assisted Laparoscopy / Q000295:instrumentation*; D006801:Humans; D020706:Laparoscopes; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Carcinoma; Hand-assisted laparoscopy; Nephrectomy; Transitional cell