手輔式併單孔後腹腔鏡腎臟及輸尿管切除手術治療上泌尿道腫瘤

陳義昇、羅啟文、許竣凱、張尚仁、謝政興

台北慈濟醫院暨慈濟大學 泌尿科

Modified hand-assisted retroperitoneoscopic nephroureterectomy with an adjunctive port for the treatment of upper urinary tract tumor

Yi-Sheng Chen, Chi-Wen Lo, Chun-Kai Hsu, Shang-Jen Chang, Cheng-Hsing Hsieh

Department of Urology, Taipei Tzu Chi Hospital and Tzu Chi University Hualien, Taiwan

Purpose: To report our experience with modified hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) for the treatment of upper urinary tract tumor.

Materials and Methods: Between Sep. 2013 and Dec. 2017, 15 patients with localized urothelial carcinoma of the upper urinary tract underwent unilateral HARNU. Through a 7-cm Gibson’s incision on the lesion side, both the distal ureterectomy and excision of bladder cuff were done with an open method without entering the bladder. Without a commercial device to keep the pneumoretroperitoneum, the surgeon's hand was placed into the retroperitoneal space while allowing the fingers to be free for manual dissection. An adjunctive port was created in midclavicular line to facilitate resection of adjacent tissues and manual dissection. Endo GIA™ Universal Roticulator 12 mm stapler was applied via the Gibson’s incision for management of renal pedicle while confirming the proper position through the adjunctive laparoscopic port.

Results: The patients mean age was 66 years. Mean operating time from manual dissection to removal of the kidney was 80 ± 33 min with an estimated blood loss of 267mL. There were neither major complications nor need for conversion in any case. Patients had earlier resumption of oral intake 24 hours on postoperative day 1, and mean hospital stay was 7 days.

Conclusions: Modified HARNU with an adjunctive port is an effective modality for the treatment of upper urinary tract tumor. Patients benefited from a shorter operating time and hospital stay with rapid convalescence and resumption of daily activity.