Retroperitoneoscopic hand-assisted nephroureterectomy using a homemade device.

Area of Science:

• Urology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Upper tract transitional cell carcinoma requires surgical intervention.
• Traditional open surgery for nephroureterectomy can be invasive.
• Minimally invasive techniques aim to reduce patient morbidity.

Purpose of the Study:

• To evaluate the safety and feasibility of hand-assisted retroperitoneoscopic nephroureterectomy (HARN) using a novel, homemade hand-assist device.
• To assess the efficacy of open bladder cuff excision in conjunction with HARN.
• To determine the cost-effectiveness of the homemade device compared to commercial options.

Main Methods:

• Twenty-four patients with upper tract transitional cell carcinoma underwent HARN with open bladder cuff excision.
• A homemade hand-assist device, constructed from an Alexis wound retractor and surgical gloves, was utilized.
• Procedures were performed via a Gibson incision and two laparoscopic ports, with pneumoretroperitoneum established at 15 mm Hg.

Main Results:

• All 24 procedures were completed without complications.
• Mean estimated blood loss was 81 mL, and mean operative time was 103 minutes.
• Patients experienced short recovery times, with oral intake resuming at 1.5 days and ambulation at 2.0 days. No device-related wound complications occurred.

Conclusions:

• Hand-assisted retroperitoneoscopic nephroureterectomy (HARN) using a homemade hand-assist device is a safe and feasible surgical option.
• The homemade device provides a significant cost reduction for HARN procedures.
• This approach represents a viable, economical alternative for managing upper tract transitional cell carcinoma.