Five Ports Method for Pure Retroperitoneoscopic Nephroureterectomy and Extraperitoneal Bladder Cuff Excision
by Wei-Yu Lin1-3*, Kuo-Tsai Huang1, Kuo-Hsiung Chiu1, Yang Tzu Hsin1, Jian-Hui Lin1, Yung-Chin Huang1,3, Dong-Ru Ho1-3,Chih-Shou Chen1,3, Tsai-Pei Huang4, Allen W. Chiu5,6
1Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
2Chang Gung University of Science and Technology, Chia-Yi, Taiwan
3Chang Gung University, Taoyuan, Taiwan
4Division of Urology, Yang Ming Hospital, Chia-Yi, Taiwan
5Institute of Clinical Research, National Yang Ming University, Taipei, Taiwan
6Department of Urology, School of Medicine, National Yang Ming University, Taipei, Taiwan
*Corresponding author: Wei-Yu Lin, Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
Received Date: 01 September, 2023
Accepted Date: 04 September, 2023
Published Date: 06 September, 2023
Citation: Lin WY, Huang KT, Chiu KH, Hsin YT, Lin JH, et al. (2023) Five Ports Method for Pure Retroperitoneoscopic Nephroureterectomy and Extraperitoneal Bladder Cuff Excision. J Surg 8: 1882 https://doi.org/10.29011/2575-9760.001882
Purpose: To describe a pure Retroperitoneoscopic Nephroureterectomy (RNU) with Distal Ureter And Bladder Cuff (DUBC) excision by a five ports method.
Methods: Standard RNU was carried out through four ports in the flank. The ureter was dissected caudally to the bladder cuff. The fifth trocar was placed at the distal end of a pre-planned Gibson’s incision to retract the ureter laterally for DUBC excision. For better visualization, the 0-degree retroperitoneoscope was shifted to the upper abdomen medial port. Ureter was dissected caudally till the ureterovesical junction. The bladder cuff was excised and clipping with an extra-large Hem-O-lock. A 5-cm incision between two trocars was made for specimen retrieval.
Results: Fifteen adult patients with Upper Tract Urothelial Cancer (UTUC) underwent the pure 5 ports RNU& DUBC excision. The mean estimated blood loss was 90 mL. The mean operating time was 220 minutes. The mean time to excise the DUBC was 30 minutes. The mean time to oral intake was at the post-operative second day. No one had local recurrence (follow-up: 1-15 months), except one had bladder recurrence, and the tumor was not located at the bladder cuff.
Conclusions: This 5-port method is technically simple for pure RNU and DUBC excision. It prevents tumor spillage, and avoids intra-operative patient repositioning.
Keywords: Distal ureter and bladder cuff; Laparoscopy; Nephroureterectomy; Upper tract urothelial carcinoma