Laparoscopic radical nephroureterectomy with only three trocars: Results of a prospective single centre study


https://doi.org/10.4081/aiua.2022.1.7
Vol. 94 No. 1 (2022)
Submitted: December 29, 2021
Accepted: January 7, 2022
Published: March 28, 2022
Nephroureterectomy, Laparoscopy, Oncological outcomes, Hospital stay, Estimated blood loss
Abstract Views: 1125
PDF: 331
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Authors

  • Yazan Al Salhi Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina; ICOT-Surgery, Orthopedics, Traumatology Institute, Latina, Italy.
  • Andrea Fuschi Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina; ICOT-Surgery, Orthopedics, Traumatology Institute, Latina, Italy.
  • Alessia Martoccia Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Gennaro Velotti Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Paolo Pietro Suraci Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Silvio Scalzo Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Onofrio Antonio Rera Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Alice Antonioni Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Fabio Maria Valenzi Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Giorgio Bozzini Urology Unit, ASST Lariana, Como, Italy.
  • Antonio Carbone Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
  • Antonio Luigi Pastore
    antopast@hotmail.com
    Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.

Introduction: Radical nephroureterectomy (RNU) with full bladder cuff excision is the gold standard for treatment of non-metastatic upper tract urothelial cancer (UTUC). We describe our technique of laparoscopic nephroureterectomy (LNU) with bladder cuff excision technique with modified port placement, reporting our long-term follow-up outcomes.
Methods: Patients affected by UTUC were prospectively enrolled and undergone to LNU. Perioperative outcomes, oncological data at 6, 12, 24 and 36 months after surgery, and all the surgical complications according to Clavien-Dindo classification were evaluated in all subjects.
Results: A total of 50 patients with UTUC underwent LNU, using this new technique without patient and port repositioning. The mean operative time was 168 minutes, estimated blood loss was 75 mL, mean length of hospital stay was 3 days. There were no intraoperative complications while four late complications occurred (two grade IIIb and two grade II according to Clavien-Dindo classification, incisional hernias and fever, respectively). Postoperative pathology was T1 in 12 patients, T2 in 17 patients, and T3 in 21 patients. Tumor grade was low in 12 patients and high in 38 patients.
Conclusions: In our study the described LNU technique was related to a significant reduction in terms of operative time and length of hospital stay, with a faster patients’ recovery and no peri and postoperative complications. The long-term oncological outcomes were similar to data reported in literature.


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Al Salhi, Y., Fuschi, A., Martoccia, A., Velotti, G., Suraci, P. P., Scalzo, S., Rera, O. A., Antonioni, A., Valenzi, F. M., Bozzini, G., Carbone, A., & Pastore, A. L. (2022). Laparoscopic radical nephroureterectomy with only three trocars: Results of a prospective single centre study. Archivio Italiano Di Urologia E Andrologia, 94(1), 7–11. https://doi.org/10.4081/aiua.2022.1.7

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