Laparoscopy and RoboticsLaparoscopic Radical Nephroureterectomy With En-Bloc Distal Ureteral and Bladder Cuff Excision Using a Single Position Pneumovesicum Method
Section snippets
Patient Positioning
After endotracheal anesthesia is established, the patient is placed in the modified lateral decubitus position with a 30° bump on the operative side. The patient's arm on the nonoperative side is padded with foam and tucked to minimize postoperative pain and possible traction injuries. The hips are left supine on the operating room table for easier access during cystoscopy and establishment of the pneumovesicum. The patient is then secured to the operating room table with 3-inch silk tape both
Comment
Laparoscopic radical nephroureterectomy is rapidly becoming the standard approach in the surgical management of patients with upper tract urothelial carcinoma. Controversy still exists on the best way to manage the distal ureter and bladder cuff during the laparoscopic approach. Multiple techniques have been used to manage the distal ureter during laparoscopic nephrouretectomy, including open incision and resection via an intravesical or extravesical approach, endoscopic, laparoscopic stapling
Conclusions
Laparoscopic techniques in urology continue to evolve. A combined laparoscopic nephroureterectomy with a pneumovesicum approach to the distal ureter is technically feasible for surgeons with advanced laparoscopic skills. This approach adheres to basic oncologic principles and offers the potential advantages of decreased morbidity and early catheter removal. Further prospective studies are needed to identify the single best approach for managing the distal ureter at the time of laparoscopic
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A novel technique for distal ureterectomy and bladder cuff excision
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2014, Wideochirurgia I Inne Techniki MaloinwazyjneLaparoscopic transvesical resection of an en bloc bladder cuff and distal ureter during nephroureterectomy
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