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KMID : 1001020110090030119
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Korean Journal of Urological Oncology
2011 Volume.9 No. 3 p.119 ~ p.123
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Modified Supine Position Hand-assisted Laparoscopic Nephrouretectomy for Upper Urinary Tract Urothelial Cell Carcinoma
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Paick Sung-Hyun
Park Hyoung-Keun
Lho Yong-Soo
Choo Gwoan-Youb
Kim Hyeong-Gon
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Abstract
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Purpose: 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.
Conslusions: MS-HALNU is easy, safe and effective treatment for patients with upper urinary tract urothelial cell carcinoma.
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KEYWORD
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Supine position, Nephrectomy, Hand-assisted laparoscopy, Ureteral neoplasm
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