Hand assisted laparoscopic bilateral nephroureterectomy in 1 session without repositioning patients is facilitated by alternating inflation cuffs.

Abstract

Transitional cell carcinoma is common and often multifocal in patients with uremia. We report a novel approach of simultaneous laparoscopic bilateral nephroureterectomy without the need to reposition patients. Seven patients with uremia and organ confined transitional cell carcinoma of the upper urinary tract underwent simultaneous laparoscopic bilateral nephroureterectomy. Inflatable cuffs of an air tourniquet device were placed beneath each side of the back. Alternatively inflating the cuffs and rotating the operation table facilitated position changes during surgery. The incision for the hand assisted device during laparoscopy was also used for resecting the distal ureters in an open manner. Data were compared with those on 7 patients treated with simultaneous open bilateral nephroureterectomy. All laparoscopic bilateral nephroureterectomies were accomplished successfully without complications except for heart failure and atlectasis in a patient with a history of myocardial ischemia. Mean blood loss (218 versus 457 ml.), parenteral narcotic requirement (25 versus 60 mg. morphine equivalent), solid food oral intake (39 versus 83 hours), postoperative hospital stay (9 versus 14 days) and convalescence to normal nonstrenuous activity (3.5 versus 5.4 weeks) were superior in the laparoscopic bilateral nephroureterectomy group. Mean operative time was about 5 hours in each group. Our data show that laparoscopic bilateral nephroureterectomy facilitated by inflatable cuffs can be performed at 1 stage with a clear operative field and no repositioning problems.