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Seo, Yu, Oh, and Rim: Early Experience of Retroperitoneoscopic Nephroureterectomy for Transitional Cell Carcinoma of Renal Pelvis and Ureter
Original Article
Korean Journal of Urology

Korean Journal of Urology 2006; 47(12): 1263-1268.

Published online: 31 December 2006

DOI: https://doi.org/10.4111/kju.2006.47.12.1263

Early Experience of Retroperitoneoscopic Nephroureterectomy for Transitional Cell Carcinoma of Renal Pelvis and Ureter

Ill Young Seo, Dong Wook Yu, Gyung-Jae Oh1, Joung Sik Rim

Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.

1Department of Preventive Medicine and Public Health, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.

Corresponding author (seraph@wonkwang.ac.kr)

Received 20 June 2006       Accepted 23 October 2006

Copyright © 2006 The Korean Urological Association

Abstract

Purpose

To evaluate the results of our experience with a retroperitoneoscopic nephroureterectomy, in patients with transitional cell carcinomas of the renal pelvis and ureter, compared to those treated by open nephroureterectomy.

Materials and Methods

Between August 2003 and February 2006, 17 patients with a transitional cell carcinoma of the upper urinary tract underwent retroperitoneoscopic nephroureterectomy. The distal ureter and bladder cuff was treated with a Gibson incision in 11 patients, with an endoscopic stapler employed in 6 patients. During the endoscopic stapler firing of the bladder cuff, complete removal of the ureteral orifice was confirmed using a flexible cystoscope. The patients' operative and clinical records were retrospectively reviewed, and compared to 16 patients with a transitional cell carcinoma of the upper urinary tract treated using an open nephroureterectomy.

Results

The retroperitoneoscopic nephroureterectomies were successfully performed in all patients. The mean operative time, transfusion rate and time to drain removal were not significantly different between the two groups. The initiations of the postoperative oral intake and ambulation, as well as the hospital stay were shorter in the retroperitoneoscopy than the open group. Complications were detected in 1 and 5 patients of the retroperitoneoscopy and open groups, respectively. With respect to the follow-up results, no statistical differences were seen in either bladder or extravesical recurrence between the two groups.

Conclusions

A retroperitoneoscopic nephroureterectomy is a less invasive technique than an open nephroureterectomy for patients with a transitional cell carcinoma of the renal pelvis and ureter. Especially, using an endoscopic stapler for the lower ureter and bladder cuff may shorten the operative time. However, long term follow-up will be necessary to confirm the cancer control effects.

Keywords: Laparoscopy, Nephrectomy, Carcinoma, transitional cell

Figures and Tables

Fig. 1
Trocar sites and incision location for right-sided procedure. A 12mm blunt tip trocar (A) is placed in the original incision, a second 5/12mm trocar (B) is placed just below the costal margin in the anterior axillary line (AAL), a third 5/11mm trocar (C) is placed 1cm below the umbilicus in the mid-axillary line (MAL), fourth 5mm trocar (D) is placed on the level of umbilicus in the posterior axillary line (PAL).
kju-47-1263-g001
Fig. 2
Laparoscopic finding of the clamped lower ureter and bladder cuff using endoscopic stapler, and cystoscopic finding of the pulled ureteral orifice (arrow).
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Table 1
Patient characteristics: number of patients (%) and mean values (standard deviation)
kju-47-1263-i001

Data were analized by chi-square test (*) or Student's t-test (†). BMI: body mass index

Table 2
Operative data and complications: number of patients (%) and mean values (standard deviation)
kju-47-1263-i002

Data were analized by chi-square test (*) or Student's t-test (†).

Table 3
Pathological findings: number of patients (%) and mean values (standard deviation)
kju-47-1263-i003

Data were analized by chi-square test (*) or Student's t-test (†).

Table 4
Postoperative follow-up results: number of patients (%) and mean values (standard deviation)
kju-47-1263-i004

Data were analized by Fisher's exact test (*) or Student's t-test (†).

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