V501 LAPARO-ENDOSCOPIC SINGLE SITE TRANSVESICAL BLADDER CUFF EXCISION

Abstract

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2011V501 LAPARO-ENDOSCOPIC SINGLE SITE TRANSVESICAL BLADDER CUFF EXCISION Rene Javier Sotelo, Juan Arriaga, Oswaldo Carmona, Robert De Andrade, Camilo Giedelman, Zehnder Pascal, Brian Irwin, Aron Monish, Mihir Desai, Inderbir Gill, and Jose Saavedra Rene Javier SoteloRene Javier Sotelo Caracas, Venezuela More articles by this author , Juan ArriagaJuan Arriaga Caracas, Venezuela More articles by this author , Oswaldo CarmonaOswaldo Carmona Caracas, Venezuela More articles by this author , Robert De AndradeRobert De Andrade Caracas, Venezuela More articles by this author , Camilo GiedelmanCamilo Giedelman Caracas, Venezuela More articles by this author , Zehnder PascalZehnder Pascal Los Angeles, CA More articles by this author , Brian IrwinBrian Irwin Burlington, VT More articles by this author , Aron MonishAron Monish Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir GillInderbir Gill Los Angeles, CA More articles by this author , and Jose SaavedraJose Saavedra Caracas, Venezuela More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.597AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present a novel technique for the management of the bladder cuff during distal ureterectomy under pneumovesicum using a single port device inserted transvesically. BACKGROUND A variety of techniques have been used to manage the distal ureter during minimally invasive nephroureterectomy for benign and malignant diseases. Each technique has distinct advantages and disadvantages that may impact intra-operative and post-operative outcomes. A general concensus has not been established. METHODS We present two cases. The first case demonstrates the technique in a patient with malignant disease in an 80 year old man with a 5cm left renal pelvic tumor. The second case shows the techniques application in a benign disease in a 25 year old woman with history of recurrent urinary tract infections in whom a CT scan showed complete duplication of the left collecting system with upper pole hydroureteronephrosis. RESULTS The first patient underwent left laparoendoscopic single site (LESS) radical nephroureterectomy with retroperitoneal lymph node dissection and bladder cuff excision under pneumovesicum for a left renal pelvic transitional cell carcinoma; final histopathology revealed pathologic G3 T3 N0 with 7 negative nodes. The operative time was 375 minutes including 45 minutes for bladder cuff excision, and estimated blood loss was 250cc. Length of stay was one day. No post-operative complications or evidence of recurrence were noted after one year of follow up. The second patient underwent LESS upper pole heminephroureterectomy for treatment of a duplicated left collecting system and upper pole hydronephrosis. Final pathology revealed chronic pyelonephritis. The operative time was 210 minutes including 30 minutes for bladder cuff excision and estimated blood loss was 400cc. The patients length of stay was three days. Postoperatively the patient was found to have lower pole renal vein thrombosis at her first postoperative visit. CONCLUSIONS LESS transvesical bladder cuff excision may offer many advantages including the ability to allow precise marking of the bladder cuff, avoiding potential injury to the contralateral ureteral orifice, and allowing water-tight closure of the bladder. It can be performed trough a small suprapubic skin incision with a small cystotomy pubic incision it can be also then used to assist the laparoscopic dissection. Additional studies are needed to identify the best approach for managing the distal ureter at the time of laparoscopic nephroureterectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e203-e204 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rene Javier Sotelo Caracas, Venezuela More articles by this author Juan Arriaga Caracas, Venezuela More articles by this author Oswaldo Carmona Caracas, Venezuela More articles by this author Robert De Andrade Caracas, Venezuela More articles by this author Camilo Giedelman Caracas, Venezuela More articles by this author Zehnder Pascal Los Angeles, CA More articles by this author Brian Irwin Burlington, VT More articles by this author Aron Monish Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Jose Saavedra Caracas, Venezuela More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...