Distal ureterectomy techniques in Laparoscopic Nephroureterectomy (LNU) and Robotic-assisted Laparoscopic Nephroureterectomy (RALNU) - A Review of the Literature.

Christos Komninos, Manolas Victor, Konstantinos Stravodimos

Abstract


Laparoscopic Nephroureterectomy and Robotic-Assisted Laparoscopic Nephroureterectomy are reported as alternative procedures to the open approach in the management of Upper Tract Transitional Cell Carcinoma (UTTCC). Although, they are considered to be equivalently effective to Open Nephroureterectomy (ONU), controversy still exists regarding the best method for managing the distal ureter and bladder cuff during the laparoscopic and robotic-assisted laparoscopic approach.

This review describes the surgical steps, the advantages and disadvantages of several techniques used for ureter and bladder cuff resection including open excision, transurethral resection of ureteral orifice (‘Pluck’ Technique), ureteric intussusception and total laparoscopy or robotic-assisted laparoscopy. Although, the existing data does not confirm the superiority of one technique over another, total laparoscopic and robotic-assisted laparoscopic nephroureterectomy with complete laparoscopic dissection and suture reconstruction of ureter and bladder cuff seem to be better tolerated than open nephroureterectomy providing equal efficacy and without deteriorating the oncological outcome. Transurethral resection of the ureteric orifice and the bladder cuff after occlusion of the ureter with a balloon catheter seems to be an attractive alternative option for low stage, low grade tumors of the renal pelvis and the proximal ureter, in case we would like to avoid a low abdominal incision.

Η Λαπαροσκοπική Νεφροουρητηρεκτομή και η Ρομποτικά Υποβοηθούμενη Λαπαροσκοπική Νεφροουρητηρεκτομή αναφέρονται ως εναλλακτικές επιλογές της Ανοικτής Νεφροουρητηρεκτομής στη διαχείριση ασθενών με Καρκίνο Αποχετευτικής μοίρας του Ουροποιητικού Συστήματος. Παρόλο που όμως θεωρούνται ισοδύναμες επεμβάσεις με την Ανοικτή Νεφροουρητηρεκτομή, παραμένει αμφιλεγόμενο ποιος τρόπος είναι ο καλύτερος όσον αφορά την αντιμετώπιση του άπω τμήματος του ουρητήρα και την εκτομή της ενδοκυστικής μοίρας αυτού.

Η παρούσα ανασκόπηση περιγράφει τα χειρουργικά βήματα και τα πλεονεκτήματακαι Μειονεκτήματα των διάφορωντεχνικών πουχρησιμοποιούνται για την εκτομή του τελικού τμήματος του ουρητήρα, όπως είναι η ανοικτή ουρητηρεκτομή, η διουρηθρική εκτομή του ουρητηρικού στομίου (‘pluck’ τεχνική), η τεχνική εγκολεασμού του ουρητήρα και η ολική Λαπαροσκοπική ή ολική Ρομποτικά-Υποβοηθούμενη Λαπαροσκοπική εκτομή του ουρητήρα. Αν και οι υπάρχουσες μελέτες δεν επιβεβαιώνουν την ανωτερότητα κάποιας τεχνικής συγκριτικά με κάποια άλλη, η ολική Λαπαροσκοπική και η ολική Ρομποτικά-Υποβοηθούμενη Λαπαροσκοπική Νεφροουρητηρεκτομή με καθολική  εκτομή της ενδοκυστικής  μοίρας του ουρητήρα και του κυστικού τοιχώματος που τον περιβάλλει φαίνεται να είναι καλύτερα Ανεκτές σε σχέση με την ανοικτήν εφροουρητηρεκτομή, παρέχοντας ισοδύναμη αποτελεσματικότητα, χωρίς να επηρεάζουν το Ογκολογικό αποτέλεσμα. Εναλλακτικά, σε περίπτωση που θέλουμε να αποφύγουμε τη Χαμηλή κοιλιακή τομή, η διουρηθρική εκτομή του ουρητηρικού στομίου, μετά από τοποθέτηση ουρητηρικού καθετήρα με μπαλόνι απόφραξης, φαίνεται να αποτελεί μια καλή επιλογή για νόσους χαμηλού σταδίου της νεφρικής πυέλου και του εγγύς μουρητήρα.


Keywords


Distal Ureterectomy; Laparoscopic Nephroureterectomy; Robotic-Assisted Laparoscopic Nephroureterectomy; Blad;Άπω ουρητηρεκτομή; Λαπαροσκοπική Νεφροουρητηρεκτομή; Ρομποτικά – Υποβοηθούμενη Λαπαροσκοπική Νεφροουρητηρεκτομή; εκτομή κυστικού τμήματος ουρητήρα

Full Text:

PDF

References


J. J. Munoz, L. M. Ellison. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. The Journal of Urology 2000; 164(5):1523–1525

M. C. Hall, S. Womack, A. I. Sagalowsky, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology 1998; 52(4): 594–601

Roupret M, Zigeuner R, Palou J, et al. European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update. Eur Urol 2011; 59: 584–594

Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM. Laparoscopic Nephroureterectomy: initial clinical case report. J Laparoendosc Surg 1991; 1: 343-349

Tsujihata M, Nonomura N, Tsujimura A, Yoshimura K, Miyagawa Y, Okuyama A. Laparoscopic Nephroureterectomy for upper tract transitional cell carcinoma: comparison of laparoscopic and open surgery. Eur Urol 2006; 49: 332–336

Viprakasit DP, Macejko AM, Nadler RB. Laparoscopic Nephroureterectomy and management of the distal ureter: A review of current techniques and outcomes. Adv Urol 2009:721371.

Klingler HC, Lodde M, Pycha A, Remzi M, Janetschek G, Marberger M. Modified laparoscopic nephroureterectomy for treatment of upper urinary tract transitional cell cancer is not associated with an increased risk of tumour recurrence. Eur Urol 2003; 44: 442–447.

Kurzer E, Leveillee RJ, Bird VG. Combining hand assisted laparoscopic nephroureterectomy with cystoscopic circumferential excision of the distal ureter without primary closure of the bladder cuff-is it safe? J Urol 2006; 175: 63–67

Keeley FX Jr, Tolley DA. Laparoscopic Nephroureterectomy: making management of upper – tract transitional cell carcinoma entirely minimally invasive. J Endourol 1998; 12: 139-142

D. M. Murphy, H. Zincke, W. L. Furlow. Management of high grade transitional cell cancer of the upper urinary tract, The Journal of Urology 1981,125; 1: 25–29

Macejko AM, Pazona JF, Loeb S,Kimm S, Nadler RB. Management of distal ureter in laparoscopic Nephroureterectomy - a comprehensive review of techniques. Urology 2008; 72 : 974–981

Rose K, Κhan S, Godbole H, Olsburgh J, Dasgupta P. Robotic-assisted retroperitenoscopic nephro-ureterectomy- first experience and the hubrid port technique. Int Clin Pract 2006; 60: 12-14

Palou J, Caparro´s J, Orsola A, et al. Transurethral resection of the intramural ureter as the first step of nephroureterectomy. J Urol 1995; 154: 43–44

Phe V, Cussenot O, Bitker MO, Roupret M. Does the surgical technique for management of distal ureter influence the outcome after nephroureterectomy? BJU Int 2011; 108: 130–138

Arango O, Bielsa O, Carles J, Gelabert-Mas A. Massive tumor implantation in the endoscopic resected area in modified nephroureterectomy. J Urol 1997; 157: 1839

Agarwal DK, Khaira HS, Clarke D, Tong R. Modified transurethral technique for the management of distal ureter during laparoscopic assisted nephroureterectomy. Urology 2008; 71: 740–743

Zou X, Zhang G, Wang X, Yuan Y, Xiao R, Wu G, Long D, Xu H, Wu Y, Liu F. A one-port pneumovesicum method in en bloc laparoscopic nephroureterectomy with bladder cuff resection is feasible and safe for upper tract transitional cell carcinoma. BJU Int 2011;108: 1497–1500

Luigi Cormio, Oscar Selvaggio, Giuseppe Di Fino, Paolo Massenio, Pasquale Annese, Jean de la Rosette, Giuseppe Carrieri. Transurethral Distal Ureter Balloon Occlusion and Detachment: A Simple Means of Managing the Distal Ureter During Radical Nephroureterectomy. J Endour 2013; 27:139-142

Gill IS, Soble JJ, Miller SD, Sung GT. A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J Urol 1999; 161: 430–434

B. J. Tan, M. C. Ost, B. R. Lee. Laparoscopic nephroureterectomy with bladder-cuff resection: techniques and outcomes. J Endour 2005; 19: 664-676

Cheng CW, Ng CF, Mak SK, Chan SY, Wong YF, Chan CK, Chan LW, Laparoscopic Transvesical Resection of an En Bloc Bladder Cuff and Distal Ureter during Nephroureterectomy. Pneumovesi- cum method in en-bloc laparoscopic nephroureterectomy with bladder cuff resection for upper-tract urothelial cancer. J Endour 2007; 21: 359–363

Stilianos Giannakopoulos, George Toufas, Charalampos Dimitriadis, et al. Laparoscopic Transvesical Resection of an En Bloc Bladder Cuff and Distal Ureter during Nephroureterectomy. Scientific World Journal. 2012; doi: 10.1100/ 2012/ 658096

C. Wong, R. J. Leveillee. Hand-assisted laparoscopic nephroureterectomy with cystoscopic en bloc excision of the distal ureter and bladder cuff. J Endour 2002; 16(6): 329–332

I. Y. Vardi, J. A. Stern, C. M. Gonzalez, S. Y. Kimm, R. B. Nadler. Novel technique for management of distal ureter and en block resection of bladder cuff during hand-assisted laparoscopic nephro-ureterectomy. Urology 2006; 67 (1): 89–92

R. V. Clayman, G. L. Garske, P. H. Lange. Total nephroureterectomy with ureteral intussusception and transurethral ureteral detachment and pull-through. Urology 1983; 21(5) :482–486

S. Roth, H. van Ahlen, A. Semjonow, L. Hertle. Modified ureteral stripping as an alternative to open surgical Ureterectomy. The Journal of Urology 1996; 155(5):1568–1571

McDougall EM, Clayman RV, Elashry O. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: The Washington University experience. J Urol 1995;154: 975–980

A. Tsivian, S. Benjamin, A. A. Sidi. A sealed laparoscopic nephroureterectomy: a new technique. European Urology 2007; 52 (4):1015-1019

McGinnis DE, Trabulsi EJ, Gomella LG, Strup SE. Hand assisted laparoscopic nephroureterectomy: description of technique. Tech Urol 2001; 7: 7–11

Nanigian DK, Smith W, Ellison LM. Robot Assisted laparoscopic Nephroureterectomy. J Endour 2006; 20: 463-465

Tracy C.R Robotic Assisted Laparoscopic Nephroureterectomy Technique. http:// emedicine. medscape.com/article/2036769

Park SY, Jeong W, Ham WS, Kim WT, Rha KH. Initial experience of robotic nephroureterectomy: a hybrid-port technique. BJU Int. 2009; 104(11): 1718-1721

Hemal AK, Stansel I, Babbar P, Patel M. Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology 2011; 78(2): 357-364

Lim SK, Shin TY, Rha KH. Current status of robot assisted laparoscopic radical nephroureterectomy for management of upper tract urothelial carcinoma. Curr Urol Rep. 2013;14(2):138-46

Cummings KB. Nephroureterectomy: rationale in the management of transitional cell carcinoma of the upper urinary tract. Urol Clin North Am 1980; 7: 569-78

Li WM, Shen JT, Li CC, Ke HL, Wei YC, Wu WJ, Chou YH, Huang CH. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol 2010; 57(6): 963-969

M. P. Laguna and J. J. M. C. H. de la Rosette. The endoscopic approach to the distal ureter in nephroureterectomy for upper urinary tract tumor. The Journal of Urology 2001; 166(6): 2017–2022

R. Ko, B. H. Chew, D. R. Hickling, H. Ravzi, P. Luke, J. Chin, J. Izawa, S. Pautler. Transitional-cell carcinoma recurrence rate after nephro- ureterectomy in patients who undergo open excision of bladder cuff ν transurethral incision of the ureteral orifice. J Endour; 21(7): 730–734

Xylinas E, Rink M, Cha EK, et al. Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol. 2012. doi:10.1016/j.eururo.2012.04.052

Χylinas E et al. Intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinomas: predictors and impact on subsequent oncological outcomes from a national multicenter study. World J Urol 2013;31:61-8

J.A Brown, S. Strup, E. Chenven, D. Bagley, L. Gomela. Hand - Assisted Laparoscopic Nephro- ureterectomy: Analysis of distal ureterectomy technique, margin status and surgical outcomes. Urology 2005; 66(6): 1192-1196

Geavlete P, Georgescu D, Bancu S, Mirciulescu V. Endoscopic ureteral procedures for one-step nephroureterectomy: experience in 100 cases. J Endour 2007; 21(9): 1019-1024

Matin SF, Gill IS. Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control. J Urol 2005; 173: 395–400

Baughman SM, Sexton W, Bishoff JT. Multiple intravesical linear staples identified during surveillance cystoscopy after laparoscopic nephroureterectomy. Urology 2003; 62: 351

Venkatesh R, Rehman J, Landman J, Lee D, Ragab ME, Sundaram CP, Humphrey PA, Clayman RV. Determination of cell viability after laparoscopic tissue stapling in a porcine model. J Endour 2005; 19(6): 744–747

R. Romero, E. M. Schaeffer, M. Muntener, B. Trock, L. R. Kavoussi, and T. W. Jarrett. Oncologic outcomes of extravesical stapling of distal ureter in laparoscopic nephroureterectomy. J Endour 2007; 21(9): 1025–1027

B. D. Seifman, J. E. Montie, J. S. Wolf Jr. Prospective comparison between hand-assisted laparoscopic and open surgical nephroureterectomy for urothelial cell carcinoma. Urology 2001; 57(1): 133–137

A. M. Ong, S. B. Bhayani, C. P. Pavlovich. Trocar site recurrence after laparoscopic nephrourete- rectomy. The Journal of Urology 2003; 170(4): 1301

Schattemann P, Chatzopoulos C, Assenmacher C, et al. Laparoscopic nephro- ureterectomy for upper urinary tract transitional cell carcinoma: results of a Belgian retrospective multicentre survey. European Urology 2007; 51(6): 1633–1638

C. R. Ritch, J. T. Kearns, A. C. Mues, G. W. Hruby, M. C. Benson, J. M. McKiernan, J. Landman. Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy. J Endour 2011; 25 (7):1149–1154




DOI: http://dx.doi.org/10.19264/hj.v26i4.46