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Complete laparoscopic nephroureterectomy with intravesical lockable clip.

Milan Hora1, Viktor Eret1, Tomáš Urge1

  • 1Department of Urology, Charles University Hospital, Pilsen, Czech Republic.

Central European Journal of Urology
|March 1, 2014
PubMed
Summary

Complete laparoscopic nephroureterectomy with an intravesical lockable clip (IVLC) is a swift and secure method for low-stage pelviureteric cancers. This technique allows for conversion to open surgery if necessary, ensuring patient safety.

Keywords:
laparoscopynephrectomyureterurothelial carcinoma

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Area of Science:

  • Urology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Low-stage pelviureteric neoplastic disease requires effective treatment.
  • Complete laparoscopic nephroureterectomy (CLNUE) is a minimally invasive approach.
  • The intravesical lockable clip (IVLC) technique offers a novel method for ureteral management during CLNUE.

Purpose of the Study:

  • To evaluate the safety and efficacy of CLNUE with IVLC for low-stage pelviureteric neoplastic disease.
  • To assess the feasibility and outcomes of this combined endoscopic-laparoscopic technique.

Main Methods:

  • A cohort of 21 patients with low-stage pelviureteric neoplastic disease underwent CLNUE-IVLC between January 2010 and January 2012.
  • The procedure involved transurethral excision of the ureterovesical junction, distal ureteral occlusion with an IVLC, followed by CLNUE.
  • The IVLC served as confirmation of complete ureterectomy.

Main Results:

  • The mean operative time was 161 minutes.
  • Clip application failure occurred in 19.0% of cases, necessitating alternative management.
  • Four complications were recorded (Clavien II, II, IIIb, V), with one patient mortality due to disease generalization.

Conclusions:

  • CLNUE-IVLC is a rapid and safe procedure for low-stage pelviureteric neoplastic disease.
  • The technique allows for conversion to open surgery if the endoscopic phase is unsuccessful.
  • Potential disadvantages include patient repositioning, risk of clip failure, and bladder defect issues.