Background: Radical nephroureterectomy (RNU) is the principal method for treatment of high-risk upper urinary tract urothelial carcinoma (UTUC). The transperitoneal approach is associated with poor disease progression, but the distal ureter-bladder cuff (DUBC) resection through retroperitoneal laparoscopic approach is difficult. This study proposed a modulated RNU technique, namely, total retroperitoneal laparoscopic radical nephroureterectomy (tRLRNU), with its advantages of DUBC resection and requiring fewer trocars etc. The efficiency, safety, and short-term impacts were retrospectively compared with total transperitoneal laparoscopic radical nephroureterectomy (tTLRNU).
Methods: Total of 12 patients who received tRLRNU and 28 patients who received tTLRNU were enrolled. The choice of surgical approach was random and their data were retrospectively analyzed. During tRLRNU, the laparoscope was versed towards the caudal direction and a retroperitoneal laparoscopic ureterectomy was performed. The bladder cuff was entirely transected and the bladder incision was sutured. The tRLRNU cases were compared with the tTLRNU cases in terms of general clinical data, pathologic parameters, peri-operative parameters, adjuvant therapy, and short-term outcomes. The independent samples -tests, chi-square tests, and Fischer exact tests were used to analyze the differences.
Results: There were no significant differences in the basic patient characteristics between the 2 groups. The data were comparable. There were significantly fewer trocars utilized in tRLRNU group compared to tTLRNU group (P=0.0008). tRLRNU group experienced less blood loss (98.33±61.32 versus 170.71±121.32 mL; P=0.017), smaller drainage volume (182.08±163.60 versus 1,924.82±3,370.02 mL; P=0.011), and shorter extubation time (5.67±1.07 versus 8.57±6.96 days; P=0.040) compared to tRLRNU group. There were no statistically differences in the other peri-operative parameters, including whole operation time, transfusion, visceral and vascular injuries, open conversion, post-operative bleeding, recovery time of intestinal function, and discharge time. The patient outcomes in tTLRNU group at 6 months were significantly worse than that of tRLRNU group by comparing progression-free survival, progression survival and mortality (P=0.039).
Conclusions: The tRLRNU was potentially safer, minimally invasive, and more effective compared to the tTLRNU. Due to the small sample size, short follow-up time and no randomization of the study, future comparative studies are warranted to further analyze long-term outcomes of tRLRNU.
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http://dx.doi.org/10.21037/tau-22-270 | DOI Listing |
JSLS
January 2025
Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan. (all authors).
Introduction: Retroperitoneal laparoscopic surgery for benign retroperitoneal tumors is often challenging because of variations in the tumor location and size. In this study, we present a retroperitoneal laparoscopic resection technique used at our institution to treat benign retroperitoneal tumors.
Materials And Methods: This retrospective case series included nine consecutive patients who underwent retroperitoneal laparoscopic tumor resection between 2011 and 2023.
Int J Surg Case Rep
January 2025
Ibn Sina University Hospital Center, Rabat, Morocco.
Introduction And Importance: Tuberculosis (TB) remains a significant public health issue, especially in developing countries where its incidence is rising due to factors like overcrowding and immunosuppression. Among extrapulmonary TB forms, abdominal TB is common, while retroperitoneal TB is rare and often challenging to diagnose due to its similarity to other retroperitoneal tumors. Diagnosis typically requires invasive procedures such as laparoscopy or laparotomy.
View Article and Find Full Text PDFTaiwan J Obstet Gynecol
January 2025
Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:
Objective: To describe a rare case of a retroperitoneal Müllerian cyst in a teenage girl with a protruding uterus and associated urogenital anomalies, and to discuss the challenges faced in differential diagnosis and management of such cases.
Case Report: We present the case of a 14-year-old girl presented with a protruding uterus for several weeks, with a history of twin-twin transfusion syndrome at birth. Initial ultrasonography identified a large pelvic cystic tumor.
J Robot Surg
January 2025
Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre, Université Paris Cité, 149, Rue de Sèvres 75015, Paris, France.
Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) is the commonest urologic procedure performed in children, entailing retroperitoneal CO2 insufflation and lateral decubitus, whose effects on cardiopulmonary variables are poorly known. We, therefore, studied hemodynamic and respiratory changes due to CO2 insufflation and lateral decubitus in children undergoing R-RALP and their effects on regional tissue oxygenation. Between 1/2021 and 7/2024, children affected by ureteropelvic joint obstruction (UPJO) underwent a pyeloplasty by R-RALP at Necker Enfants Malades Hospital (Paris, France), using a standardized surgical technique and a lung-protecting anesthetic protocol aimed to prevent hypercarbia.
View Article and Find Full Text PDFIntroduction: Local recurrence for upper tract urothelial carcinoma typically occurs within 2 years post-surgery. We report a rare case of retroperitoneal recurrence as squamous cell carcinoma 10 years after nephroureterectomy.
Case Presentation: A 67-year-old female was referred to our urology department for a left ureteral tumor.
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