Laparoendoscopic Single-Site Nephroureterectomy and En Bloc Resection of Bladder Cuff with an Endoloop

Abstract

Introduction: To present the initial experience of laparoendoscopic single-site (LESS) nephroureterectomy via the transperitoneal approach using a homemade single port and bladder-cuff resection by endoloop. Materials and Methods: LESS nephroureterectomy was performed with a homemade single port created using an Alexis wound retractor as an access platform through a 4-cm incision over umbilicus.1 This video included a brief presentation of a 57-year-old woman who presented with painless gross hematuria. An upper tract high-grade urothelial carcinoma was identified. The LESS nephroureterectomy and bladder-cuff resection were performed through the same incision over the umbilicus. The distal ureters were resected with an endoloop.2 The procedure was completed. No additional ports were used. The outside shots demonstrating the maneuvering the instruments were also included in our slides. Results and Conclusions: Between August 2009 and May 2010, we have performed LESS nephroureterectomy for five consecutive patients with upper tract urothelial carcinomas. The mean operative time was 284.0 ± 94.9 minutes. The mean estimated blood loss was 70.0 ± 24.5 mL. The mean hospital stay was 5.6 ± 3.5 days. Complete bladder-cuff resection was confirmed grossly in all cases. None of our cases had a urinary leakage, which was confirmed by cystography postoperatively. There is only one laparoscopic conversion caused by tight adhesions of renal hilum surroundings, which made progress difficult. There was no operation-related complication. Histopathologic examination demonstrated negative-resection margins in all cases. Our initial experience revealed that LESS nephroureterectomy and use of endoloop to complete bladder-cuff resection is a safe and feasible procedure for upper urinary tract urothelial carcinoma. Further prospective and long-term studies are warranted to provide more solid evidence with regard to perioperative benefits and oncologic control. All authors have declared no conflicts of interest. Runtime of video: 8 mins 45 secs