V03-07: Pure endoscopic closure of bladder wall after transurethral disinsertion of distal ureter during laparoscopic nephroureterectomy: proof of concept in humans
In laparoscopic radical nephroureterectomy (RNU) for upper urinary tract urothelial cancer, endoscopic disinsertion of distal ureter is very common. However, several studies report a higher incidence of cancer recurrence in the bladder after endoscopic management of distal ureter. A single post-operative dose of chemotherapy, soon after surgery reduces the risk of bladder tumor recurrence within the first year post-RNU. However, bladder water tightness after endoscopic disinsertion of distal ureter is crucial for immediate administration of intravesical chemotherapy. In this video we present our technique for pure endoscopic closure of the bladder wall in humans submitted to RNU for upper urinary tract urothelial carcinoma.
Within a prospective single-center study, 3 female patients with upper urinary tract urothelial carcinoma were proposed for laparoscopic RNU with transurethral disinsertion of distal ureter and Pure Endoscopic Closure of Bladder Wall. Endoscopic closure of bladder wall was performed using a 26 Fr nephroscope, a 3-mm laparoscopic needle holder and a 15cm 2/0 V-Loc ® stitch. First, endoscopic resection of ureteral meatus and intra-mural ureter was performed using a Collins Knife. Next, a 26 Fr Nephroscope was introduced through the urethra into the bladder. A 3-mm needle holder was passed transuretrally, lateral to the nephroscope and the V-Loc ® stitch was passed through the nephroscope to the bladder. After this, a transmural, continuous suture of the bladder wall was performed. Water tightness was tested filling the bladder with methylene blue after completion of laparoscopic RNU. Mitomycin C was administered to all patients immediately after completion of laparoscopic RNU and complications were recorded.
Pure Endoscopic Closure of Bladder Wall after transurethral disinsertion of distal ureter was carried out easily and quickly in all patients. The laparoscopic view revealed no acute leak of methylene blue dye after distension of the bladder. Immediate mitomycin C was administered to all patients without any post-operative complication recorded.
This study demonstrates the feasibility and safety of Pure Endoscopic closure of the Bladder Wall after transurethral disinsertion of distal ureter during laparoscopic RNU, thus allowing safe immediate administration of intravesical chemotherapy. This study also provides support for Pure Endoscopic Closure of Bladder Wall in other clinical situations in humans.