The Korean Journal of Urological Oncology 2011;9(3):119-123.
Published online December 30, 2011.
상부 요상피암에 대한 변형된 앙와위 손을 이용한 복강경 신요관적출술
백성현, 박형근, 노용수, 추관엽, 김형곤
건국대학교 의학전문대학원 비뇨기과학교실
Modified Supine Position Hand-assisted Laparoscopic Nephrouretectomy for Upper Urinary Tract Urothelial Cell Carcinoma
Sung Hyun Paick , Hyoung Keun Park , Yong Soo Lho , Gwoan Youb Choo , Hyeong Gon Kim
Department of Urology, Konkuk University School of Medicine, Seoul, Korea
Correspondence:  Hyeong Gon Kim
We developed modified supine position hand-assisted laparoscopic nephroureterectomy(MS-HALNU) without position change during the operation in patients with upper urinary tract urothelial cell carcinoma. So, we report these results. Materials and Methods: Twenty two patients(including three with metastatic cancer) with upper urinary tract urothelial cell carcinoma underwent a unilateral MS-HALNU. Patient's position was supine but operation side was elevated 30 degree with soft pad. An 8cm Gibson incision on the operation side was performed for a distal ureterectomy and bladder cuff excision, which were carried out as open surgery. The nephroureterectomy was followed without position change using hand-assisted technique via the same incision and two additional 10mm ports. Results: All 22 MS-HALNUs were successfully completed without open conversion; there were no major complications. The average operation time was 257 minutes and the average estimated blood loss was 173ml. The average interval to resuming oral intake was 2.6 days and the average hospital stay was 8.6 days. The average follow-up period was 30.1 months. In 15 localized cases(below T2), no recurrence occurred. However, in four T3 cases, 3 recurrences(2 bladder) occurred even with adjuvant chemotherapy. In 3 palliative cases, all patients died due to disease progression. Conclusions: MS-HALNU is easy, safe and effective treatment for patients with upper urinary tract urothelial cell carcinoma. (Korean J Urol Oncol 2011;9:119-123)
Key Words: Supine position, Nephrectomy, Hand-assisted laparoscopy, Ureteral neoplasm

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