Initial Experience of Laparoendoscopic Single-site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Urothelial Carcinoma Performed by a Single Surgeon

Abstract

Purpose: 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. Patients and Methods: 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. Results: The mean age was 62.79 +/- 7.93 years. The mean total operative time, time for nephrectomy, and time for bladder cuff excision were 225.63 +/- 65.87, 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. Conclusions: LESSNU for upper urinary tract urothelial carcinoma seems to be feasible and safe, but it is still challenging for advanced cases.