Laparoendoscopic single-site nephroureterectomy for morbid obese patients
| Autor: | Antonio Carlos Lima Pompeo, Marcos Tobias-Machado, Cesar Augusto Braz Juliano, Renato Meirelles Mariano da Costa Jr, Alexandre Stievano Carlos |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Biopsy Urology Operative Time lcsh:RC870-923 Nephrectomy Abdominal wall Ureter medicine Carcinoma Humans Retroperitoneal space Pelvis Ureteral Neoplasms business.industry Abdominal Wall Reproducibility of Results Middle Aged lcsh:Diseases of the genitourinary system. Urology medicine.disease Carcinoma Papillary Obesity Morbid Surgery Retractor Treatment Outcome medicine.anatomical_structure Cuff Feasibility Studies Female Laparoscopy business Renal pelvis |
| Zdroj: | International braz j urol v.39 n.6 2013 International Braz J Urol Sociedade Brasileira de Urologia (SBU) instacron:SBU International Brazilian Journal of Urology, Vol 39, Iss 6, Pp 895-896 (2013) International braz j urol, Volume: 39, Issue: 6, Pages: 895-896, Published: DEC 2013 |
| Popis: | Since the first laparoendoscopic single-site (LESS) surgery report in urology in 2007 (1) (Rane A e Cadeddu JA), the few reports of LESS extraperitoneal access in the literature were mainly described for less complex cases. The aim of this video is to demonstrate the feasibility of LESS extraperitoneal access in a morbid obese patient presenting a malignant tumor in the renal pelvis. The patient is positioned in 90-degree lateral decubitus. An incision is made below the abdominal skin crease on the left side of the patient and the anterior rectus fascia is vertically incised with manual dissection of the extra/retroperitoneal space. We use an Alexis® retractor to retract the skin maximizing the incision orifice. Three trocars (12, 10 and 5 mm) are inserted through a sigle-port. The pedicle was controlled "en bloc" with a vascular stapler and the bladder cuff treated by the conventional open approach through the same incision. Operative time was 126 minutes with minimal blood loss. The pathology reported high grade papillary urothelial carcinoma in the pelvis (pT3N0M0) and in the ureter (pTa). LESS extraperitoneal nephroureterectomy is feasible and safe, even in more complex cases. It is a good alternative for morbid obese patients and for patients with synchronous distal ureteral tumors for whom an open approach to the bladder cuff is proposed to avoid incisions in two compartments of the abdominal wall. |
| Databáze: | OpenAIRE |
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