創新的腹腔外單孔腹腔鏡腎臟輸尿管切除手術
治療上泌尿道尿路上皮癌—初步報告
黃逸修1,2,3、邱文祥2,3 范玉華1,2,3 黃志賢1,2,3 張延驊1,2,3 林登龍1,2,3 陳光國1,2,3
1臺北榮民總醫院 泌尿部； 2台北市立聯合醫院；
3國立陽明大學 醫學系 泌尿學科，書田泌尿科學研究中心
Preliminary results of a novel extraperitoneal less nephroureterectomy for urothelial carcinoma of upper urinary tract
Eric Yi-Hsiu Huang1,2,3, Allen W. Chiu2,3, Yu-Hua Fan1,2,3, William JS Huang1,2,3, Yen-Hwa Chang1,2,3, Alex T.L. Lin1,2,3, Kuang-Kuo Chen1,2,3
1Department of Urology, Taipei Veterans General Hospital; 2Taipei City Hospital;
3Shu-Tien Urological Science Research Center, Department of Urology, School of Medicine,
National Yang-Ming University, Taipei, Taiwan
Purpose:
Urothelial carcinoma of upper urinary tract (UTUC) is a rare disease. Nephroureterectomy and excision of bladder cuff is the standard of surgical treatment. The approaches for this surgery have evolved enormously in the past few decades. Laparoendoscopic single site (LESS) surgery is one of the surgical options with the advantages of fast recovery and good cosmesis. We reported our preliminary results of a completely extraperitoneal LESS approach via a Gibson’s incision, which is a novel way of access in performing this operation.
Materials and Methods:
From September 2013 to September 2014, 10 patients accepted LESS retroperitoneal nephroureterectomy with excision of bladder cuff through a 5 Gibson’s incision by a single surgeon. GelPOINT (Applied medical) was adopted as the access platform. The mean age of the patients was 76.3 years (range 56-87). There were 4 male and 6 female.
Results:
All the procedures were smoothly carried out without sequela. The mean total operation duration was 330 minutes (range 230-430). The mean duration for nephrectomy was 163.8 (range 120-230). The mean blood loss of nephrectomy was 145 mL (range 50-300). There was no conversion to open or conventional laparoscopic approach. Transperitoneal LESS approach was performed in one patient due to obvious violation of the peritoneum. There were no post-operative events. The cosmesis was satisfactory.
Conclusion:
The preliminary results of our novel LESS retroperitoneal approach for nephroureterectomy with excision of bladder cuff were promising. Such approach may be one of the choices for the surgical treatment of UTUC.