Background: Selecting the treatment procedure for cancer patients is a challenging task. We report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).
Methods: A total of four patients with UTUC underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien–Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU, consisting of laparoscopic nephrectomy with open bladder cuff excision) for pain scale evaluation.
Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period (median, 10 months). Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31).
Conclusions: We described our initial experience and outcome of complete laparoscopic RNU for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.
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Posted 15 May, 2020
On 03 May, 2020
On 02 May, 2020
On 02 May, 2020
On 02 May, 2020
Received 27 Apr, 2020
Received 22 Apr, 2020
On 22 Apr, 2020
Received 22 Apr, 2020
On 21 Apr, 2020
On 21 Apr, 2020
On 07 Apr, 2020
Invitations sent on 07 Apr, 2020
On 06 Apr, 2020
On 06 Apr, 2020
On 05 Apr, 2020
Received 02 Apr, 2020
Received 01 Apr, 2020
On 22 Mar, 2020
Invitations sent on 19 Mar, 2020
On 19 Mar, 2020
On 18 Mar, 2020
On 17 Mar, 2020
On 17 Mar, 2020
On 16 Mar, 2020
Posted 15 May, 2020
On 03 May, 2020
On 02 May, 2020
On 02 May, 2020
On 02 May, 2020
Received 27 Apr, 2020
Received 22 Apr, 2020
On 22 Apr, 2020
Received 22 Apr, 2020
On 21 Apr, 2020
On 21 Apr, 2020
On 07 Apr, 2020
Invitations sent on 07 Apr, 2020
On 06 Apr, 2020
On 06 Apr, 2020
On 05 Apr, 2020
Received 02 Apr, 2020
Received 01 Apr, 2020
On 22 Mar, 2020
Invitations sent on 19 Mar, 2020
On 19 Mar, 2020
On 18 Mar, 2020
On 17 Mar, 2020
On 17 Mar, 2020
On 16 Mar, 2020
Background: Selecting the treatment procedure for cancer patients is a challenging task. We report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).
Methods: A total of four patients with UTUC underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien–Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU, consisting of laparoscopic nephrectomy with open bladder cuff excision) for pain scale evaluation.
Results: The novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for two weeks. No patient experienced recurrent disease during the follow-up period (median, 10 months). Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P=0.31).
Conclusions: We described our initial experience and outcome of complete laparoscopic RNU for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
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