Suprapubic-assisted laparoendoscopic single-site surgery for nephroureterectomy:Report of 8 cases

Objective:To evaluate the feasibility and efficacy of suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS)for nephroureterectomy,and to discuss its key technique issues.Methods:Eight patients(two of them with renal pelvic carcinoma,two with ureteral carcinoma,one with renal pelvic carcinoma combined with ureteral carcinoma,two with renal tuberculosis,and one with megaureter and empyema)were subjected to SALESS nephroureterectomy.The patient was administrated general endotracheal anesthesia and secured on the operating table in lateral decubitus with affected side elevated 70°.Two trocars were inserted at the medial margin of umbilicus,and one was inserted into abdominal cavity below the pubic hairline.The operation was performed using conventional operating instruments,under direct vision achieved by a 5mm flexible-tip 0°laparoscope.Firstly,the distal ureter was isolated completely and blocked by a Hem-o-lok clip.Then,the nephrectomy was performed according to the method of the standard laparoscopy.Finally,the bladder cuff excision was performed and the incision was sutured.The specimen was removed after the incisions below the pubic hairline was enlarged transversely and the rectus abdominis muscle sheath was incised vertically.Results:All the procedures were successfully performed.The median operative time was 165(range 115to 220)minutes,and the median estimated blood loss was 140(range 50to 200)ml.There was no major perioperative complication occurred.All the patients resumed ambulation on postoperative day 1.The abdominal and pelvic drainage tube was removed on postoperative day 2-3.Urethral catheter was removed on postoperative day 6-7(the tumor patients underwent irrigation of bladder with Pirarubicin).The patients were discharged on postoperative day 8.Conclusions:SA-LESS nephroureterectomy appears to be feasible and effective with faster postoperative recovery,shorter hospitalization time and better cosmetic results.