Zhang Sd

Laparoendoscopic single-site radical cystectomy and urinary diversion: initial experience in China using a homemade single-port device.

PURPOSE We report our initial experience with the first series of laparoendoscopic single-site (LESS) radical cystectomy and urinary diversion performed by a single surgeon using a homemade single-port device at a single institution in China. PATIENTS AND METHODS Between December 2010 and February 2011, we performed five LESS radical cystectomis using a homemade single-port device composed of an inverted cone device of polycarbonate and a powder-free surgical glove. The port was placed into a 5-cm periumbilical incision. The conventional laparoscope and laparoscopic instruments were inserted through the single-port. No additional ports were needed for radical cystoprostatectomy and bilateral standard pelvic lymphadenectomy. Cutaneous ureterostomy and ileal conduit urinary diversion were used for our patients, respectively. Perioperatively, oncologic data and complications were collected and analyzed. RESULTS All the procedures were completed successfully. The mean extirpative operative time was 208.2 (168-280) minutes, estimated blood loss was 270 (100-500) mL, bowel recovering time was 9.75 (6-12) days, and postoperative hospital stay was 19.5 (14-28) days. One patient needed a transfusion of 400 mL of red blood cells. The pathologic evaluation revealed negative margins and negative lymph node involvement. After the operations, one patient had a bowel obstruction, while another patient died from cardiac disease. Mean follow-up time was 143 (110-173) days. CONCLUSIONS In our experience, LESS radical cystectomy is clinically feasible and safe for selected patients, but requires a learning curve. Our homemade single-port device is a cost-effective and convenient device. Although the initial outcomes have been promising, the long-term oncologic evaluation of these patients awaits.

Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique

Objective Laparoscopic knot-tying and suturing are the most difficult steps in shortening the warm ischemia time and learning curve of laparoscopic nephron-sparing surgery. This study was performed to demonstrate the safety, oncological efficacy, and technical tips of sutureless retroperitoneal laparoscopic nephron-sparing surgery (RPNSS). Methods This retrospective study included 78 cases of RPNSS using a sutureless technique and 126 cases of RPNSS using a single-layer barbed self-retaining suture technique performed from December 2012 to December 2016. Results The mean warm ischemia time was significantly shorter in the sutureless technique group than in the barbed self-retaining suture technique group (6.8 vs. 21.1 minutes, respectively). There was no significant difference in the mean age, body mass index, R.E.N.A.L. Nephrometry score, operative time, maximal tumor diameter, intraparenchymal depth, blood loss, operative time, transfusion rate, complication rate, or postoperative hospital stay between the two groups. No open conversion was needed. No positive margins or local recurrence were observed during follow-up. Conclusions The sutureless technique was proven to be safe and oncologically effective and may allow novice laparoscopic surgeons to easily and quickly master RPNSS, a technically difficult procedure.

AB065. Totally retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy (Mayo 0-3)

Background and Objective Management of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of totally retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy in such patients. Patients and Methods From July 2014 to May 2015, 12 patients underwent laparoscopic radical nephrectomy for renal cell cancer combined with tumor thrombus of the inferior vena cava. Thrombus extension classified by the Mayo Clinic and the 2009 TNM classifications, complications, postoperative management, and survival results were analyzed. The surgeries were performed by retroperitoneal approach totally. For substantial level I-III involvement, complete caval isolation, including laparoscopic control of infra-renal and supra-renal IVC, contra-lateral renal vein and lumbar veins was performed. Following thrombus extraction, the cavotomy was repaired with 4-0 prolene suture on RB-1 needle. Results Four patients had level 0, two patients had level I, five had level II, and one had level III thrombi according to the Mayo Clinic staging, and 11 were T3c and one was T4 according to the 2009 TNM classifications. Totally retroperitoneal laparoscopic approach was performed in patients with stage 0 to 3 thrombi. There was no intraoperative mortality and open conversion. The median follow-up interval was 8.6 months. Conclusions Renal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that Mayo level 0-3 caval vein tumor thrombus can be safely surgically treated by totally retroperitoneal laparotomy.