Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: Progressive adaptation to retroperitoneocopic approach

• Published in: Actas urológicas españolas (English ed.) 2018-12, Vol.42 (10), p.649-658
• Main Authors: Baldissera Aradas, J.V., Rodríguez Villamil, L., Fernández-Pello Montes, S., Gil Ugarteburu, R., Mosquera Madera, J.
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma de células transicionales del tracto urinario superior; Carcinoma, Transitional Cell - surgery; Cystoscopy; Desinserción láser; Female; Holmium laser; Humans; Kidney Neoplasms - surgery; Laparoscopy; Laser disinsertion; Lasers, Solid-State - therapeutic use; Láser de holmio; Male; Middle Aged; Nefroureterectomía; Nephroureterectomy; Nephroureterectomy - methods; Patient Positioning; Retroperitoneal Space; Transitional cell carcinoma of the upper urinary tract; Ureter; Ureteral Neoplasms - surgery
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2018.10.006

The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-μm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumor. The endoscopic technique was then started. Both approaches were simultaneously employed. Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases. La técnica de desinserción ureteral con rodete vesical continúa su evolución. Presentamos la técnica láser-endoscópica transuretral combinada con abordaje trans y retroperitoneal laparoscópicos en decúbito lateral, sin reposicionamiento del paciente para carcinomas uroteliales del tracto urinario superior. Presentamos 3 nefroureterectomías laparoscópicas, una trans y 2 retroperitoneales. La desinserción se realizó en decúbito lateral utilizando un cistoscopio flexible y una fibra de 365μ de laser Holmio. La técnica endoscópica se adaptó progresivamente a los abordajes retroperitoneoscópicos de 3 puertos y puerto único. Antes de la manipulación laparoscópica del riñón el uréter fue clipado por debajo del tumor, iniciándose posteriormente la técnica endoscópica. Ambos abordajes se combinaron simultáneamente. Se lograron nefroureterectomías con desinserción endoscópica del rodete vesical en bloque, garantizando un sistema cerrado, comparable con la técnica abierta. El segundo caso precisó reconversión por problemas técnicos y prolongación del tiempo quirúrgico. No se diagnosticaron recidivas durante el seguimiento. Los