Departamento de Urologia, AC Carmargo Cancer Center, São Paulo, SP, Brasil.
Int Braz J Urol. 2021 Sep-Oct;47(5):1072-1073. doi: 10.1590/S1677-5538.IBJU.2020.1006.
: One of the most remarkable characteristics of urothelial carcinomas is multifocality. However, occurrence of synchronous bladder cancer and upper urinary tract urothelial cancer (UTUC) is exceptional. Minimally invasive approach for these synchronous tumors was just occasionally reported (1-4). The aim of this video article is to describe step-by-step the technique for simultaneous laparoscopic nephroureterectomy and robot-assisted anterior pelvic exenteration with intracorporeal ileal conduit urinary diversion (ICUD). Patients and methods: A 66-year-old female presented with synchronous BCG refractory non-muscle invasive bladder cancer and a right-side UTUC. She was a former smoker and had previously been submitted to multiple transurethral resections of bladder tumor, BCG and right distal ureterectomy with ureteral reimplant. We performed a simultaneous laparoscopic right nephroureterectomy and robot-assisted anterior pelvic exenteration with totally intracorporeal ICUD. Combination of robot-assisted and pure laparoscopic approaches was proposed focusing on optimization of total operative time (TOT).
: Surgery was uneventful. TOT was of 330 minutes. Operative time for nephroureterectomy, anterior pelvic exenteration and ICUD were 48, 135, 87 minutes, respectively. Estimated blood loss was 150mL. Postoperative course was unremarkable and patient was discharged after 7 days. Histopathological evaluation showed a pT1 high grade urothelial carcinoma plus carcinoma in situ both in proximal right ureter and bladder, with negative margins. Twelve lymph nodes were excised, all of them negative.
: In our preliminary experience, totally minimally invasive simultaneous nephroureterectomy and cystectomy with intracorporeal ICUD is feasible. Pure laparoscopic approach to upper urinary tract may be a useful tactic to reduce total operative time.
尿路上皮癌的最显著特征之一是多灶性。然而，同时发生膀胱癌和上尿路尿路上皮癌（UTUC）是罕见的。对于这些同步肿瘤，微创方法只是偶尔有报道（1-4）。本文的目的是描述同时进行腹腔镜肾输尿管切除术和机器人辅助前盆腔切除术，同时进行腔内回肠导管尿流改道（ICUD）的分步技术。
一名 66 岁女性患有同步卡介苗难治性非肌肉浸润性膀胱癌和右侧 UTUC。她是一名前吸烟者，曾多次接受经尿道膀胱肿瘤切除术、卡介苗和右侧远端输尿管切除术及输尿管再植术。我们同时进行了腹腔镜右侧肾输尿管切除术和机器人辅助前盆腔切除术，完全采用腔内 ICUD。我们提出了机器人辅助和纯腹腔镜方法的组合，重点是优化总手术时间（TOT）。
手术顺利。TOT 为 330 分钟。肾输尿管切除术、前盆腔切除术和 ICUD 的手术时间分别为 48、135 和 87 分钟。估计失血量为 150 毫升。术后过程无明显异常，患者在 7 天后出院。组织病理学评估显示右侧近端输尿管和膀胱的 pT1 高级别尿路上皮癌加原位癌，切缘阴性。切除了 12 个淋巴结，均为阴性。
在我们的初步经验中，完全微创同时进行肾输尿管切除术和膀胱切除术，同时进行腔内 ICUD 是可行的。对上尿路采用纯腹腔镜方法可能是减少总手术时间的有用策略。
