V6-12: Transvescicoscopic bladder cuff excision in laparoscopic nephroureterectomy
To describe the management of the distal ureter during laparoscopic radical nephroureterectomy with the transvesical laparoscopic approach.
The patient was placed in the modified lithotomy position with abducted thighs. The procedure started with cystoscopic examination of the bladder and ureteral orifices. After a small skin incision, a 5-mm-diameter trocar was introduced into the bladder dome. The anterior bladder wall was suspended to the abdominal wall to prevent the trocar from slipping out and 2 more 3-mm-diameter trocars were placed. The ureter was mobilized with hook electrocautery and dissected ureteral end was placed in extravesical space. Bladder was repaired with 4-0 vicryl. Then patient was placed in lateral position and conventional laparoscopic radical nephroureterectomy was performed. While dissection of distal ureter, the distal end of ureter was smoothly removed from perivesical space without any difficulty.
The patient was a 61-year-old female. The patient’s CT scan showed right proximal ureteral mass and the result of previously performed ureteroscopic biopsy was transitional cell carcinoma, low grade. The operation time of transvesical bladder cuff excision was 50 minutes, and laparoscopic nephroureterectomy was performed for 120 minutes. Estimated blood loss of whole procedure was 300ml and there was no intraoperative or postoperative complication. Foley catheter was removed at 1 week. After 6 months postoperatively, there’s no evidence of recurrence or metastasis.
Our initial experience with transvesicoscopic bladder cuff excision in laparoscopic radical nephroureterectomy demonstrated that the procedure is feasible and safe.