Pneumovesicum method in en-Bloc laparoscopic nephroureterectomy with bladder cuff resection for upper-tract
Chi Wai Cheng1, Chi Fai Ng, Siu King Mak
1Urology Team, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
Background And Purpose:
A novel technique for managing the distal ureter and bladder cuff during laparoscopic nephroureterectomy is introduced.
Technique:
The procedure consists of three steps: (1) cystoscopy and PediPort (Tyco) insertion; (2) establishment of pneumovesicum and intramural ureter mobilization; and (3) laparoscopic nephroureterectomy. The use of PediPorts, a 5-mm lens, and Ski needles greatly facilitates the pneumovesicum. The ureteral orifice is closed, and the intramural ureter is dissected out with the patient in the lithotomy position. Laparoscopic nephroureterectomy is then accomplished with the patient in the lateral position.
Results:
The postoperative course was uneventful, and the pathology examination showed clear margins.
Conclusion:
Pneumovesicum is a minimally invasive approach that provides an excellent endoscopic view. It is an oncologically sound method, as the ureteral orifice is closed early, and the chance of cancer-cell spillage is minimized by the use of gas instead of liquid in the bladder. Moreover, the procedure is not technically demanding.
