Extraperitoneal Laparoscopic Radical Nephroureterectomy and Lymph Node Dissection in Modified Supine Position

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Upper tract urothelial carcinoma (UTUC) management often involves radical nephroureterectomy.
• Traditional open surgery can lead to significant morbidity.
• Minimally invasive techniques are increasingly explored for UTUC.

Purpose of the Study:

• To assess the feasibility and outcomes of extraperitoneal laparoscopic radical nephroureterectomy (EL-RNU) and lymph node dissection (LND).
• To evaluate this approach in a modified supine position for UTUC in the renal pelvis or upper ureter.

Main Methods:

• A consecutive series of 15 patients with high-risk UTUC underwent EL-RNU and extraperitoneal laparoscopic lymph node dissection (EL-LND).
• Data collected included operative time, blood loss, postoperative recovery, complications, and oncologic outcomes.
• Histologic nodal status and recurrence rates were analyzed.

Main Results:

• All 15 patients completed EL-RNU and EL-LND in the modified supine position without conversion to open surgery.
• Mean operative time was 178 minutes, with a mean blood loss of 140 mL.
• No local recurrence or distant metastasis was observed at a median follow-up of 14.4 months, with 20% nodal positivity.

Conclusions:

• EL-RNU and EL-LND in a modified supine position are feasible and minimally invasive for UTUC.
• Maintaining peritoneal integrity and achieving good exposure of major vessels are crucial for success.
• This approach demonstrates promising oncologic control for selected UTUC patients.