Korean J Urol.  2014 Jan;55(1):29-35. 10.4111/kju.2014.55.1.29.

Hand-Assisted Retroperitoneoscopic Nephroureterectomy With Bladder Cuffing After Preperitoneal and Retroperitoneal Perivesical Ballooning

• Kim CH
• Kim KT
• Kim KH
• Yoon SJ

• KMID: 1988449
• DOI: http://doi.org/10.4111/kju.2014.55.1.29

Abstract

PURPOSE
We aimed to describe the surgical technique of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) with bladder cuffing after preperitoneal and retroperitoneal perivesical ballooning.
MATERIALS AND METHODS
From March 2008 to September 2012, we performed HARNU and open bladder cuffing in 28 consecutive series of patients with upper urinary tract urothelial carcinoma. We performed HARNU according to the following procedure: (1) a camera port incision was made on the posterior axillary line; (2) multiple, repeated, preperitoneal and retroperitoneal ballooning was performed on both the posterior axillary line and in the umbilicus; (3) a 7.0 cm skin incision was made from the suprapubic to the lower inguinal with the balloon present in the extraperitoneal area; (4) hand-assisted laparoscopic retroperitoneal nephroureterectomy; (5) cessation of gas insufflation; and (6) extravesical cuffing as an open surgical procedure.
RESULTS
The mean estimated blood loss was 250 mL. The mean operation time was 240 minutes. The mean time to oral intake and ambulation was 1.0 day and two days, respectively. As for postoperative complications due to the hand-assisted device, one patient developed febrile urinary tract infection within three weeks postoperatively and was hospitalized again to receive parenteral antibiotics.
CONCLUSIONS
We made a low Gibson incision for a route for the hand-assisted procedure as well as a window for open surgery in dissecting the distal ureter and extracting the surgical specimens. Thus, our results indicate that the HARNU might be a feasible surgical modality.

Keyword

Endoscopy; Hand-assisted laparoscopy; Nephrectomy; Transitional cell carcinoma; Ureteral neoplasms

MeSH Terms

Anti-Bacterial Agents
Carcinoma, Transitional Cell
Endoscopy
Hand-Assisted Laparoscopy
Humans
Insufflation
Nephrectomy
Postoperative Complications
Skin
Umbilicus
Ureter
Ureteral Neoplasms
Urinary Bladder*
Urinary Tract
Urinary Tract Infections
Walking
Anti-Bacterial Agents

Figure

• 

  FIG. 1 Port arrangement and position of surgeon and assistant during hand-assisted retroperitoneoscopic nephroureterectomy for a right-handed surgeon. (A) For right-sided nephroureterectomy. (B) For left-sided nephroureterectomy. The solid line shows the lower Gibson incision for the hand port. O, operator; C, camera assistant; A, additional assistant; MAL, midaxillary line; PAL, posterior axillary line; 12th, 12th rib.

• 

  FIG. 2 Balloon dilation for the left nephroureterectomy. (A) Bidirectional balloon dilation. (B) The preperitoneal balloon dilator identified through a lower Gibson incision. (C) The retroperitoneal balloon dilator identified in the same patient.

Reference

1. Steinberg JR, Matin SF. Laparoscopic radical nephroureterectomy: dilemma of the distal ureter. Curr Opin Urol. 2004; 14:61–65.

2. Matin SF, Gill IS. Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control. J Urol. 2005; 173:395–400.

3. Busby JE, Matin SF. Laparoscopic radical nephroureterectomy for transitional cell carcinoma: where are we in 2007? Curr Opin Urol. 2007; 17:83–87.

4. Seo IY, Yu DW, Oh GJ, Rim JS. Early experience of retroperitoneoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter. Korean J Urol. 2006; 47:1263–1268.

5. Capolicchio JP, Saemi A, Trotter S, Plante MK. Retroperitoneoscopic nephrectomy with a modified hand-assisted approach. Urology. 2011; 77:607–611.

6. Ko R, Chew BH, Hickling DR, Razvi H, Luke PP, Chin JL, et al. Transitional-cell carcinoma recurrence rate after nephroureterectomy in patients who undergo open excision of bladder cuff v transurethral incision of the ureteral orifice. J Endourol. 2007; 21:730–734.

7. Terakawa T, Miyake H, Hara I, Takenaka A, Fujisawa M. Retroperitoneoscopic nephroureterectomy for upper urinary tract cancer: a comparative study with conventional open retroperitoneal nephroureterectomy. J Endourol. 2008; 22:1693–1699.

8. Hemal AK, Kumar A, Gupta NP, Seth A. Retroperitoneal nephroureterectomy with excision of cuff of the bladder for upper urinary tract transitional cell carcinoma: comparison of laparoscopic and open surgery with long-term follow-up. World J Urol. 2008; 26:381–386.

9. Goel A, Hemal AK, Gupta NP. Retroperitoneal laparoscopic radical nephrectomy and nephroureterectomy and comparison with open surgery. World J Urol. 2002; 20:219–223.

10. Nakashima K, Fujiyama C, Tokuda Y, Satoh Y, Nishimura K, Nakashima N, et al. Oncologic assessment of hand-assisted retroperitoneoscopic nephroureterectomy for urothelial tumors of the upper tract: comparison with conventional open nephroureterectomy. J Endourol. 2007; 21:583–588.

11. Kawauchi A, Fujito A, Ukimura O, Yoneda K, Mizutani Y, Miki T. Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure. J Urol. 2003; 169:890–894.

12. Uozumi J, Fujiyama C, Meiri H, Tsukahara T, Soejima K, Kanou T, et al. Hand-assisted retroperitoneoscopic nephroureterectomy for upper urinary-tract urothelial tumors. J Endourol. 2002; 16:743–747.

13. Chung SD, Huang CY, Chueh SC, Pu YS, Lai MK, Yu HJ, et al. Intermediate follow-up of hand-assisted retroperitoneoscopic nephroureterectomy for management of upper urinary tract urothelial carcinoma: comparison with open nephroureterectomy. Urology. 2007; 69:1030–1034.

14. Compton C, Byrd D, Garcia-Aguilar J, Kurtzman S, Olawaiye A, Washington M. Renal pelvis and ureter. In : Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer Publishing;2010. p. 493.

15. Ou CH, Yang WH, Tzai TS, Tong YC, Chang CC, Lin YM. A modified supine position to speed hand assisted retroperitoneoscopic nephroureterectomy: the Johnnie Walker position. J Urol. 2006; 176:2063–2067.

16. Ou CH, Yang WH. Bilateral hand-assisted retroperitoneoscopic nephroureterectomy (HARN) in the spread-eagle position for dialysis patients-low midline HARN in a completely supine position. Urology. 2011; 77:363–367.

17. Ou CH, Yang WH. Hand assisted retroperitoneoscopic nephroureterectomy with the patient spread-eagled: an approach through a completely supine position. J Urol. 2008; 180:1918–1922.

18. Chen J, Chueh SC, Hsu WT, Lai MK, Chen SC. Modified approach of hand-assisted laparoscopic nephroureterectomy for transitional cell carcinoma of the upper urinary tract. Urology. 2001; 58:930–934.

19. Ou CH, Yang WH. Retroperitoneoscopic hand-assisted nephroureterectomy using a homemade device. J Laparoendosc Adv Surg Tech A. 2013; 23:48–51.