Introduction: We describe another variant of nephroureterectomy – antegrade mini-invasive nephroureterectomy (AMNUE). Methods: AMNUE starts with a laparoscopic nephrectomy in the flank position. The specimen is enclosed in a bag without dividing the ureter, and the patient is positioned to the lithotomy position. Then the ureterovesical junction is excised transurethrally with a Collins knife. Finally, the specimen is removed and the ureter is plucked out through a short lower abdomen incision. Patients: From March 2005 to November 2008, 35 patients underwent nephroureterectomy: 7 as an open procedure, 8 as a laparoscopic nephrectomy with open ureterectomy, 8 as a complete laparoscopic nephroureterectomy, and 12 were admitted into the AMNUE group (7 men and 5 women, mean age 71 ± 7 years, range 54–81 years). Results: Tumors were found 6 times on both sides. The mean operation time was 165 ± 32 min (105–210 min), and the mean blood loss was 150 ± 91 ml (50–400 ml). Histology revealed 11 urothelial cancers and 1 papillary renal cell carcinoma. There was only 1 hematoma of the abdominal wall. Conclusion: AMNUE is a fast, safe and easily reproducible technique. It eliminates the risk of spillage of tumorous cells into the urine, which is possible in techniques where the ureter is excised with a Collins knife as the first procedure. The disadvantages of this approach are the necessary repositioning of the patient and that the long-term oncological results are currently unknown. AMNUE can be used when a complete laparoscopic nephroureterectomy is not technically feasible due to problems in the pelvis.

Keywords:
Urothelial tumor, Nephroureterectomy, Laparoscopy, Retroperitoneoscopy, Transurethral resection
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© 2009 S. Karger AG, Basel
2009
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