針對上泌尿道上皮癌患者後腹腔鏡腎输尿管切除術後

在預定的Gibson切口下端置入5毫米套管切除遠端輸尿管膀胱袖口

賴淳熙^1,2、林威宇^2,3,4

嘉義長庚紀念醫院教學部¹；長庚大學醫學院²；嘉義長庚紀念醫院泌尿科³；

國立成功大學醫學院 ⁴

Insertion of 5 mm Trocar in Lower End of Planned Gibson Incision for Management of Distal Ureter and Bladder Cuff Following Retroperitoneoscopic Nephroureterectomy for Upper Tract Urothelial Cancer

Chun-Hsi Lai^1,2, Wei-Yu Lin^2,3,4

Department of Medical Education, Chang Gung Memorial Hospital, Chiayi, Taiwan¹;

School of Medicine, Chang Gung University, Taoyuan, Taiwan²;

 Division of Urology, Chang Gung Memorial Hospital, Chiayi, Taiwan³;

College of Medicine, National Cheng Kung University, Tainan, Taiwan⁴

Purpose: To address the limitations encountered during retroperitoneoscopic (RPS) nephroureterectomy (NU) in managing the challenging distal ureter and bladder cuff (DUBC), we aimed to describe an alternative method and report its outcomes, aiming to improve surgical visualization and facilitate smoother surgical procedures.

Methods: After RPS NU, we inserted a 5 mm trocar in planned Gibson’s incision to manage DUBC. The RPS was switched to upper abdomen medial trocar to visualize the deep field of pelvic cavity. The 5 mm trocar was used to retract the ureter laterally for distal ureter dissection and management of bladder cuff with Hem-o-lok. 19 patients diagnosed with UTUC were treated with this procedure.

Results: The DUBC was removed completely under this method and no complications directly related to this method were recorded. The median follow-up period was over 8 years (8~11), and only 2 of them recurrence at surgical margin site. Another 9 cases were suspected recurrence afterward, but not at surgical margins.

Conclusions: This method is technically simple for management of DUBC during RPS NU. The merits include more clear visualization of deep pelvic cavity, complete excision of DUBC, avoids intra-operative patient repositioning, and low rate of recurrence at surgical margin site after long term follow up.