Simultaneous Laparoscopic Nephroureterectomy and Cystectomy: our experience
Abstract
Patients with muscle-invasive bladder cancer and concomitant upper urinary tract tumors may be candidates for simultaneous cystectomy and nephroureterectomy. Other clinical conditions such as dialysis-dependent end-stage renal disease and non-functioning kidney are also indications for simultaneous removal of the bladder and kidney. In the present video, we report our laparoscopic experience with simultaneous laparoscopic radical cystectomy (LRC) and nephroureterectomy.
Our surgical technique was performed as follows through a trans-peritoneal approach. First surgical time was rapresented by nephroureterectomy. After recognizing the ureter, the kidney was completely isolated from the perirenal fat and the ureter followed down to the intersection with the iliac vessels. For subsequent cystectomy and bilateral lymph-node dissection, the patient was re-positioned in a supine position and 2 more accesses (10- and 5-mm trocars) were placed in the iliac fossa. In this position we completed the ureter isolation without dissecting it. Radical cystectomy was performed with a descending approach. . Bilateral iliac-obturator extended lymphadenectomy and separate extraction of lymph-node specimens. The ureter was now identified and ejected from the corresponding side access. Specimens were extracted through a 6-cm skin incision along the linea alba. Monolateral ureterocutaneostomy.