Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
J Endourol. 2011 Nov;25(11):1763-8. doi: 10.1089/end.2010.0729. Epub 2011 Aug 24.
To present our experience with the first 10 consecutive cases of laparoendoscopic single-site nephroureterectomy (LESSNU) with bladder cuff excision for upper tract urothelial carcinoma.
Ten patients (6 men and 4 women; 6 renal pelvis and 4 ureter) underwent LESSNU by a single surgeon. We made a 4-cm single incision at the umbilicus using a homemade single-port device. The single-port device was made with a surgical glove and Alexis wound retractor. LESSNU was performed by the same technique of conventional laparoscopic NU.
The mean age was 62.79 ± 7.93 years. The mean total operative time, time for nephrectomy, and time for bladder cuff excision were 225.6 ± 365.87, 80.00 ± 29.03, and 145.63 ± 42.63 minutes. The mean estimated blood loss was 187.50 ± 83.45 mL. On surgical pathologic examination, four patients were pT(1)N(0), four patients were pT(2)N(0), one patient was pT(3)N(0), and one patient was pT(3)N(2). There was one positive surgical margin in a pT(3)N(2) patient. The mean number of lymph nodes dissected was 2.5 (range 0-9). One incision extension was performed because of complete renal hilar lymphadenectomy by open technique (for the pT(3)N(2) patient), and one open conversion with a Gibson incision was performed because of severe adhesions around the distal ureter (the pT(3)N(0) patient). There were one case of transient ileus and one of fever that were improved with conservative treatment. The mean hospital stay was 4.75 ± 3.37 days. Eight patients who underwent LESSNU successfully were satisfied with their operations.
LESSNU for upper urinary tract urothelial carcinoma seems to be feasible and safe, but it is still challenging for advanced cases.
介绍我们施行 10 例连续腹腔镜单部位肾输尿管全长切除术（LESSNU）加膀胱袖套切除治疗上尿路上皮癌的经验。
由同一位医师为 10 例患者（6 例男性，4 例女性；肾盂癌 6 例，输尿管癌 4 例）施行 LESSNU。我们在脐部做一个 4cm 的单一切口，使用自制的单孔装置。该单孔装置由手术手套和 Alexis 伤口牵开器制成。LESSNU 采用与传统腹腔镜 NU 相同的技术进行。
患者的平均年龄为 62.79±7.93 岁。平均总手术时间、肾切除术时间和膀胱袖套切除时间分别为 225.6±365.87 分钟、80.00±29.03 分钟和 145.63±42.63 分钟。平均估计失血量为 187.50±83.45mL。术后病理检查结果，4 例患者为 pT(1)N(0)，4 例为 pT(2)N(0)，1 例为 pT(3)N(0)，1 例为 pT(3)N(2)。1 例 pT(3)N(2)患者有 1 处切缘阳性。平均切除的淋巴结数为 2.5 枚（0-9 枚）。1 例患者因开放技术行完全肾门淋巴结清扫而进行切口延长，1 例患者因远端输尿管周围严重粘连而改行 Gibson 切口开放转换。有 1 例患者发生短暂性肠梗阻，1 例患者发热，均经保守治疗后好转。平均住院时间为 4.75±3.37 天。成功施行 LESSNU 的 8 例患者对手术结果满意。
腹腔镜单部位肾输尿管全长切除术治疗上尿路上皮癌似乎是可行且安全的，但对于晚期病例仍具有挑战性。
