医学
袖口
外科
解剖(医学)
输尿管
围手术期
上尿路
肾切除术
膀胱切除术
手术切缘
泌尿科
泌尿系统
膀胱癌
肾
癌症
内科学
切除术
作者
Zhenjie Wu,Mingmin Li,Jianchao Wang,Alessandro Veccia,Yifan Xu,Chao Zhang,Junlong Ren,Yin Li,Ming Chen,Junkai Wang,Danfeng Xu,Zongqin Zhang,Bing Liu,Bo Yang,Liping Xie,Le Qu,Linhui Wang
出处
期刊:Minerva urology and nephrology
[Edizioni Minerva Medica]
日期:2020-04-10
卷期号:73 (3): 392-400
被引量:5
标识
DOI:10.23736/s0393-2249.20.03711-x
摘要
Background Concerns have been raised regarding the management of bladder cuff with these minimally invasive approaches. The aim of this study was to describe a modified radical nephroureterectomy (RNU) with pure retroperitoneoscopic extravesical standardized seeable (PRESS) bladder cuff excision (BCE) and to assess its outcomes based on a novel concept of intraoperative trifecta. Methods Twenty-four patients with upper urinary tract urothelial carcinoma underwent retroperitoneoscopic RNU from August 2017 to August 2019. A modified RNU with PRESS BCE and lymph node dissection (LND) was performed. Descriptive analysis of patients' characteristics, surgical technique, perioperative outcomes, and follow-up data was performed. BCE trifecta was defined as en-bloc excision, mucosa-to-mucosa reliable closure and no urine spillage. Results In 23 out of 24 cases (95.8%) the procedure was successfully completed. One patient was converted to open distal ureterectomy with a Gibson incision due to peritoneum rupture during dissection of the distal ureter. BCE trifecta was achieved in 95.7% (22/23) cases of all patients finished with PRESS technique. Median OT was 260 min (IQR: 220-305) with median EBL of 100 mL (IQR: 100-250). Median OT for distal ureterectomy was 52 min (IQR: 40-69). No positive surgical margin occurred. Median postoperative hospital stay was 6 d (IQR: 5-7). Median follow-up time was 7 mo (IQR: 5-17). One patient (4.3%) experienced bladder recurrence and no patient developed distant metastasis or died of the disease. Conclusions Herein, we demonstrate a standardized retroperitoneoscopic RNU technique that is safe and reproducible, enabling the visual confirmation of complete BCE and facilitating LND. BCE trifecta should be a routine goal in minimally invasive RNU. Prospective comparison with the standard open surgical technique is warranted.
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