A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes

Liming Song,1,* Wenkuan Wang,2,* Qinxin Zhao,3,* Yuhong Wen,4 Xiaoguang Zhou,1 Hu Han,1 Xiaodong Zhang1 1Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Urology, Beijing Haidian Hospital/Haidian Hospital of Beijing University Third Hospital, Beijing, People’s Republic of China; 3Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 4Department of Urology, Huhehaote First Hospital, Inner Mongolia, People’s Republic of China*These authors contributed equally to this workCorrespondence: Liming SongDepartment of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, People’s Republic of ChinaEmail bjslm2020@163.comBackground: The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes.Methods: From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient’s characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed.Results: LNU was performed successfully on all 106 patients. There was no significant difference in patients’ characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (P=0.001), less estimated blood loss (EBL) (P< 0.001), lower visual analogue scale (VAS) pain score (P=0.020) and less scarring (P=0.013). The median time of surgical drain stay decreased from 5 to 2 days (P=0.004) and median hospital stay after surgery decreased from 5 to 3 days (P=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (P=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (P< 0.001).Conclusion: The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.Keywords: nephroureterectomy, laparoscopy, retroperitoneal, transperitoneal, single position