Elsevier

Urology

Volume 72, Issue 4, October 2008, Pages 850-852
Urology

Laparoscopy and Robotics
Laparoscopic Radical Nephroureterectomy With En-Bloc Distal Ureteral and Bladder Cuff Excision Using a Single Position Pneumovesicum Method

https://doi.org/10.1016/j.urology.2008.05.052Get rights and content

We describe a completely laparoscopic approach for en-bloc dissection of the distal ureter and bladder cuff during nephroureterectomy using a pneumovesicum approach and with the need for intraoperative patient repositioning. This technique is efficient, technically feasible and adheres to the oncologic principles of radical nephroureterectomy.

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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