Transvaginal natural orifice transluminal endoscopic surgery(NOTES)-assisted hybrid endoscopy in nephroureterectomy(Report of 2 cases)

2012 
Objective:To describe the initial clinical experience of transvaginal NOTES-assisted hybrid endoscopy in nephroureterectomy,and evaluate its feasibility and efficacy. Method:A 54-year-old and a 58-year-old female patient with renal pelvis cancer underwent transvaginal NOTES-assisted hybrid endoscopy for nephroureterectomy.After induction of general anesthesia,the patients were positioned in lithotomywith ipsilateral lumbar at 60° angle to the operating table.Two trocars were inserted in the umbilical edge for conventional operating instruments,and a trocar was inserted through the posterior vaginal fornix for laparoscope.First,the ipsilateral lower ureter wasdissected and clipped with Hem-o-lock clips near the bladder.Second,the pneumovesicum method was applied with CO2 insufflation,a resectoscope was inserted into the bladder,and dissection was performed circumferentially through the entire detrusor muscle to disconnect the ureter from the bladder wall.Third,laparoscopicnephroureterectomy was performed.The specimen was placed inside a homemade bag and removed through an extended incision at posterior vaginal fornix. Result:Both procedures were successfully completed without major injury.The operative time was 245 and 185 min,respectively.The estimated blood loss was 150 and 100 ml,respectively.There was no need for transfusion in both cases.Seven days after surgery,each patient underwent irrigation of bladder with Pirarubicin.Both patients were discharged on postoperative day 8.Conclusion:Transvaginal NOTES-assisted hybrid endoscopy in nephroureterectomy is feasible and effective with good cosmetic result.
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