Lai Weil R, Lee Benjamin R
Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA.
Asian J Urol. 2016 Jul;3(3):120-125. doi: 10.1016/j.ajur.2016.04.001. Epub 2016 May 11.
Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy, with the distal ureter and bladder cuff mobilized through a separate open pelvic incision. To decrease morbidity, urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy. In many published series of laparoscopic nephroureterectomy, the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the "pluck" technique, with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage. While the distal ureter and bladder cuff can be excised laparoscopically, it does require advanced laparoscopic skills. With the wrist articulation and stereoscopic vision in robotic surgery, robotic nephroureterectomy (RNU) and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight, mucosa to mucosa fashion after excising the bladder cuff. In this review, we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.
从历史上看，上尿路临床器官局限型高级别尿路上皮癌的治疗方法包括开放性肾输尿管切除术，远端输尿管和膀胱袖口通过单独的开放性盆腔切口进行游离。为了降低发病率，泌尿外科医生越来越多地采用腹腔镜和机器人技术来进行肾输尿管切除术。在许多已发表的腹腔镜肾输尿管切除术系列研究中，远端输尿管和膀胱袖口通过一种改良的“拔取”技术在内镜下从膀胱分离，由此产生的膀胱缺损通过长时间留置尿道导管引流来愈合。虽然远端输尿管和膀胱袖口可以通过腹腔镜切除，但这确实需要先进的腹腔镜技术。借助机器人手术中的腕关节活动和立体视觉，机器人肾输尿管切除术（RNU）和膀胱袖口切除术可以以顺行方式进行，以模仿开放技术，并且在切除膀胱袖口后能够以水密、黏膜对黏膜的方式在体内闭合膀胱缺损。在这篇综述中，我们讨论了在腹腔镜和RNU过程中切除远端输尿管和膀胱袖口的已发表的微创技术。
