Laparoendoscopic Single-Site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Transitional-Cell Carcinoma: Technical Details Based on Oncologic Principles

Abstract

Purpose: To describe our technical details of laparoendoscopic single-site (LESS) nephroureterectomy with bladder cuff excision for the management of upper urinary tract transitional-cell carcinoma (TCC) based on oncologic principles. Patients and Methods: Two patients underwent LESS nephroureterectomy for upper urinary tract TCC. In both cases, we used a homemade single-port device that consisted of a wound retractor and a surgical glove. Using the flexible laparoscopic instruments, nephrectomy was performed using procedures similar to those of conventional laparoscopic nephrectomy. Bladder cuff excision was performed laparoscopically using the same procedure with open technique. Results: All procedures were completed successfully without conversion to conventional laparoscopic or open surgery and without additional extraumbilical trocars or incisions. LESS nephreoureterectomy with bladder cuff excision was performed in 385 and 285 minutes with estimated blood loss of 100 and 350 mL, respectively. Both patients were discharged on postoperative day 3 without perioperative complications. Conclusions: LESS nephroureterectomy with bladder cuff excision for upper urinary tract TCC is a minimally invasive technique that may reproduce the open surgical technique and adhere to oncologic principles.