Laparoendoscopic Single-Site Nephroureterectomy

Abstract

The standard treatment for patients with upper urinary tract transitional cell carcinoma (TCC) is surgical removal of the kidney and ureter with bladder cuff excision. Because of reasonable outcome compared with open surgery, laparoscopic nephroureterectomy (NU) became alternative treatment option for upper urinary tract TCC with minimal invasiveness. Recently, laparoendoscopic single-site surgery (LESS) has been gradually evolving in urologic fields. A few studies of LESS NU have been reported with early experiences (Rais-Bahrami et al., Arch Esp Urol. 2012;65:311–317, Seo et al., Kor J Urol. 2010;51:472–476, Lee et al., J Endourol. 2011;25:1763–1768, Park et al., BJU Int. 2013;112(5):610–615). In these studies, perioperative outcomes seem to be similar with those of conventional laparoscopic NU. LESS NU is more difficult than other LESS urologic surgeries because of the extreme range of surgical field. LESS NU has two broad objectives. First is nephrectomy in cephalic field, and second is distal ureterectomy in caudal field. These extremities make some limitations with LESS technique. Same as laparoscopic NU, LESS NU also have some debate about optimal management of the distal ureter and surrounding bladder cuff. In an attempt to adhere to the oncologic principles, various techniques have been used when performing distal ureterectomy and bladder cuff excision, including standard extravesical open excision of bladder cuff technique (Waldert et al., BJU Int. 2009;103:66–70), cystoscopic resection of the ureteral orifice (modified pluck technique) (Kural et al., J Endourol. 1997;11(2):131–134, Hayashi et al., Int J Urol. 2005;12(6):539–543), and laparoscopic stapling of the bladder cuff (Shalhav et al., J Urol. 2000 163(4):1100–1104).

This chapter describes the procedure of LESS NU and management technique for distal ureter and bladder cuff.