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Technical innovations
Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer
Makito Miyake
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9503-7356
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This work is licensed under a CC BY 4.0 License. Read Full License
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.
Keywords
Upper urinary tract urothelial cancer, Transvesical laparoscopy, Complete laparoscopy, Pneumovesicum, Numeric pain rating scale
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On 21 Apr, 2020
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Editor invited
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Editorial decision: Major Revision
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Received 02 Apr, 2020
Review #1 received
Received 01 Apr, 2020
Reviewer #2 agreed
On 22 Mar, 2020
Reviewers invited
Invitations sent on 19 Mar, 2020
Reviewer #1 agreed
On 19 Mar, 2020
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This preprint is under consideration at World Journal of Surgical Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Technical innovations
Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer
Makito Miyake
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9503-7356
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 15 May, 2020
No community comments so far
Editor assigned
On 03 May, 2020
Submission checks complete
On 02 May, 2020
Editor invited
On 02 May, 2020
No comments provided
Editorial decision: Major Revision
On 02 May, 2020
Review #1 received
Received 27 Apr, 2020
Review #2 received
Received 22 Apr, 2020
Reviewer #3 agreed
On 22 Apr, 2020
Review #3 received
Received 22 Apr, 2020
Reviewer #1 agreed
On 21 Apr, 2020
Reviewer #2 agreed
On 21 Apr, 2020
Editor assigned
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
Editor invited
On 06 Apr, 2020
No comments provided
Editorial decision: Major Revision
On 05 Apr, 2020
Review #2 received
Received 02 Apr, 2020
Review #1 received
Received 01 Apr, 2020
Reviewer #2 agreed
On 22 Mar, 2020
Reviewers invited
Invitations sent on 19 Mar, 2020
Reviewer #1 agreed
On 19 Mar, 2020
Editor assigned
On 18 Mar, 2020
Submission checks complete
On 17 Mar, 2020
Editor invited
On 17 Mar, 2020
First submitted
On 16 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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