V11-13: Laparoendoscopic Single Site Nephroureterectomy: Technique & Initial Experience
VideoIntroductions and Objectives
Open radical nephroureterectomy remains the “gold standard” treatment for upper urinary tract urothelial carcinoma. Laparoendoscopic single site (LESS) nephroureterectomy has raised significant interest worldwide to reduce morbidity and scarring associated with conventional laparoscopy._x000D_ _x000D_ The objective of this study is to investigate the techniques, safety and feasibilities of LESS nephroureterecomy for upper urinary tract urothelial carcinoma.
We retrospectively reviewed a prospectively maintained database to identify patients who underwent laparoendoscopic single site nephroureterectomy for upper urinary tract urothelial carcinoma. Perioperative data were recorded along with functional and oncological outcomes._x000D_ _x000D_ Our technique was performed using the GelPOINT device (Applied Medical, Rancho Santa Margarita, CA, USA) through a peri-umbilical incision. We placed four ports into the GelPOINT (3x10mm and 1x12mm). Our management of the distal ureter and badder cuff mimicked those of the open approach in all cases. The bladder cuff was dissected circumferentially around the ureteric orifice. The bladder defect was closed with continuous running barbed V-Loc (Covidien, Dublin, Ireland).
_x000D_ A total of three patients were identified (2 female, 1 male) from July 2013 to July 2014. _x000D_ The mean age was 66 years old (59-69 and mean BMI was 26._x000D_ There were two left sided upper urinary tract tumour and one right sided upper urinary tract tumour. Of these tumours two were located in the upper ureter and one was in the mid ureter. _x000D_ The mean pre-operative and post-operative creatinine was 90 umol/L and 110 umol/L respectively. The mean estimated blood loss was 266 mL and the mean total operative time was 210 minutes. The mean length of hospital stay was 3 days._x000D_ None of the patients were converted to open surgery. There was one post operative complication of urinary tract infection. None of the patients required blood transfusion. The final histology confirmed one high grade Ta urothelial carcinoma and two high grade T1 urothelial carcinoma. Of the two high grade T1, one has concurrent carcinoma in-situ._x000D_ There was no positive surgical margin. At the median follow up of 6 months there was no local or distal recurrences
Our initial LESS nephroureterectomy experience is comparable to other minimal invasive & open series. There is a potential in the future for long term follow up analysis across multi-institutions. Significant improvements are required to address the current challenges of LESS. Careful selection of patients for LESS nephroureterectomy is crucial