Outcomes and Complications of Simultaneous Laparoscopic Cystectomy and Laparoscopic Nephroureterectomy with Umbilical Reduced Port Surgery

Yutaro Tanaka,Takahiro Kobayashi,Ryosuke Chaya,Takahiro Yasui,Daichi Kobayashi,Takehiko Okamura,Hidetoshi Akita,Takashi Nagai

doi:10.31557/apjcp.2018.19.12.3495

Abstract

Objective:In recent years, although reduced port surgeries (RPS) have been reported for many urological diseases, there have been no reports regarding simultaneous laparoscopic cystectomy and unilateral or bilateral nephroureterectomy with umbilical RPS. Therefore, the aim of this study was to evaluate outcomes and complications of simultaneous laparoscopic cystectomy and unilateral or bilateral nephroureterectomy with umbilical RPS.Methods:We performed a preliminary case series of 4 patients with synchronous upper urinary tract (UUT) tumor and invasive bladder cancer who underwent simultaneous laparoscopic cystectomy and unilateral or bilateral nephroureterectomy with umbilical RPS between 2014 and 2017 at our hospital. Demographic data, pathologic features, the surgical technique, and outcomes were retrospectively analyzed.Result:All 4 patients were men whose median age was 79 years (range 65-85 years) and median body mass index was 24.2 kg/m2 (range 21.5-27.3 kg/m2). The laparoscopic approach was technically successful in all 4 patients without the need for open conversion. The median total operative time was 434 minutes (range 372-481 minutes). The median estimated blood loss was 773 ml (range 153-923 ml), median interval to resuming oral intake was 2 days (range 1-7 days), and median hospital stay was 16 days (range 13-20 days).Conclusion:The reduced port approach is technically feasible in terms of many outcome measures, with significant cosmetic advantages. This method can be performed safely and recommended as a viable option for patients with concomitant UUT and bladder cancer.

Highlights

Urothelial carcinoma (UC) can involve the urinary bladder as well as ureters and the renal pelvis
In the field of urology, a case report of laparoscopic simultaneous radical cystectomy and nephroureterectomy was initially written by Deng et al, (2002) and the first series of eight patients was published by Barrows et al, (2008)
We describe our initial clinical results of 4 patients who underwent simultaneous laparoscopic radical cystectomy and unilateral or bilateral nephroureterectomy with umbilical reduced port surgeries (RPS) between 2014 and 2017 at our hospital

Summary

Introduction

Urothelial carcinoma (UC) can involve the urinary bladder as well as ureters and the renal pelvis. Radical cystectomy and nephroureterectomy are standard procedures for bladder and upper urinary tract (UUT) malignancies. In patients with recurrent high grade or muscle invasive bladder UC and concomitant UUT tumors, simultaneous cystectomy and nephroureterectomy is the principle oncologic procedure of choice (Witjes et al, 2014). Other clinical conditions, such as dialysis-dependent end-stage renal disease and non-functioning kidney, are indications for simultaneous removal of the bladder and kidney. In the field of urology, a case report of laparoscopic simultaneous radical cystectomy and nephroureterectomy was initially written by Deng et al, (2002) and the first series of eight patients was published by Barrows et al, (2008). Laparoscopic surgery including RPS has been continued to be used and developed over the past decade to improve cosmetic results and to reduce patient invasiveness (Hermans et al, 2014; Tang et al, 2014; Aboumarzouk et al, 2013)

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Conclusion