A one-port pneumovesicum method in en bloc laparoscopic nephroureterectomy with bladder cuff resection is feasible and safe for upper tract transitional cell carcinoma

OBJECTIVE To introduce a modified method for managing the distal ureter in laparoscopic nephroureterectomy (LNU) for upper tract transitional cell carcinoma (TCC) and to evaluate the feasibility and safety of this method. PATIENTS AND METHODS Six consecutive patients underwent LNU using a one-port pneumovesicum method for pathologically confirmed upper tract TCC. Each patient was placed on the operating table in the lithotomy position and the pneumovesicum method was applied with CO(2) insufflation. Dissection was performed circumferentially through the entire detrusor muscle to disconnect the ureter from the bladder wall. A 10-mm trocar was placed into the bladder above the pubic bone. The distal ureter was occluded using a Hem-o-lok clip and pushed out of the bladder. Laparoscopic nephroureterectomy was then performed with the patient in the lateral position. After surgery, all six patients received systemic chemotherapy and follow-up. RESULTS All procedures were performed successfully. The median (range) operating time for the complete procedure was 105 (85-140) min, and the median (range) estimated blood loss was 125 (60-230) mL. Seven days after surgery, each patient underwent cystography, which confirmed no extravasation of urine. None of the patients developed bladder tumour recurrence or metastatic disease during follow-up. CONCLUSIONS The one-port pneumovesicum method in LNU, which is applied to manage the distal ureter and bladder cuff, is technically feasible and safe. The method simplifies management of the distal ureter, reduces the invasiveness of the procedure and improves cosmesis.