Nephroureterectomy

Following the first report of hand-assisted laparoscopy for nephroureterectomy, a single case among a series of 22 laparoscopic nephroureterectomies reported by Keeley and Tolley (28), there have been 10 series reported, totaling 196 cases (Table 4) (29-38). Resection of the distal ureter was performed in a variety of manners, including open resection of a bladder cuff, laparoscopic resection of a bladder cuff with either sutured or stapled closure, and transurethral resection of the bladder cuff. The mean operating time, including repositioning and removal of the distal ureter, was 315 minutes, not

TABLE3 ■ Published Hand-Assisted Laparoscopy Partial Nephrectomy Series

Mean

Mean OR

Mean

No. of pts with

No. of pts

No. of pts with

Mean

mass size

time

EBL

postoperative

with urine

other minor/major

hospital

No. of pts.

(cm)

(min)

(mL)

hemorrhage

leak

complications3

stay (days)

Wolf et al. (24)b

10

2.4

199

460

0

0

2/1

2

Stifelman et al. (25)

11

1.9

274

319

0

0

2/0

3.3

Brown et al. (26)

30

2.6

218

415

2

6

1/0

4

Pruthi et al. (27)

15

2.7

129

173

0

0

1/0

2.7

Total

66

2.5c

204c

351c

3.0%d

9.1%d

9.1%/1.5%d

3.3c

aIncludes blood transfusions not accounted for in delayed hemorrhage column. bOf the 10 cases, two were standard laparoscopy. ^Weighted mean.

dPercentage occurrence of summed totals. Abbreviations: OR, operating room; EBL, estimated blood loss.

TABLE4 ■ Published Hand-Assisted Laparoscopy Nephroureterectomy Series

No. of pts with

No. conversion

Mean

-

Method for

Mean OR

minor/majorc

to open

hospital stay

Mean follow

No. nonvesical

No. of pts.

distal ureter

time (min)

omplications

surgery

(days)

up (mo)

recurrence

Chen et al. (29)

7

Open

224

0

7.3

7.8

0

Seifman et al. (30)

16

TUR

320

3/3

1

3.9

18

0

McGinnis et al. (31)

32

Laparoscopic, sutured

372

5/3

0

5.5

13

0

Li et al. (32)

10

Various

267

1

7.6

Chueh et al. (33)

7

Open

294

-

8.8

Landman et al. (34)

16

Laparoscopic, stapled

294

2/2

1

4.5

9.6

3

Wong and Leveillee (35)

14

Endoscopic cuff

0

2

8

0

Uozumi et al. (36)

10

456

4/1

0

0

Munver et al. (37)

30

Various

289

1/2

0

4.6

33

2

Kawauchi et al. (38)

54

Various

296

4/4

2

-

17

4

Total

196

315a

12%/9.5%b

2.6%b

5.0a

17.6a

bPercentage occurrence of summed totals.

Abbreviations: OR, operating room; TUR, transurethral resection.

including the 2.6% of patients in whom the procedure was converted to open surgery. The overall minor and major complication rates were 12% and 9.5%, respectively. With a mean follow-up of 17.6 months, the nonvesical recurrence rate has been 5.5%.

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