Laparoscopic ureteral reconstruction in gynaecological recurrent cancer surgeries: an initial case series study

In combined resection of the bladder and ureter during laparoscopic surgery for gynaecological recurrent cancer, some cases require laparoscopic ureteral reconstruction techniques. In the open surgery approach, it has been reported that gynaecological advanced or re-current tumour surgeries solely conducted by a gynaecologic group, with combined resection of multiple organs, improves the prognosis. However, to the best of our knowledge, in the minimally invasive surgery approach, there are no reported case series in the field of gynaecological recurrent tumour surgery conducted by only a gynaecologic group, with combined resection of the bladder and ureter. Therefore, we conducted this pilot study to describe the feasibility of laparoscopic gynaecologic recurrent malignant tumour surgery involving ureteral reconstruction. We retrospectively searched our patient database for women with gynaecological cancer who under-went laparoscopic ureteral reconstruction techniques in gynaecological recurrent cancer surgeries. Nine patients underwent laparoscopic ureteral reconstruction for long-segment ureteral defects in gynaecologic surgeries. In all cases, R0 surgical resection were successfully performed. The ureteral defect lengths ranged from 3.5-10 cm (median, 4 cm). The Boari flap was necessary in one of the eight cases with a ureteral defect of less than 8 cm. The ureteral defect was less than 12 cm in all cases, but substitution was required in three cases. In all cases except one, no urinary complications occurred. In conclusion, it is feasible for a gynaecologist to perform laparoscopic ureteral reconstruction combined resection of the bladder and ureter during laparoscopic surgery for gynaecological recurrent cancer.

Ureteral reconstruction; Boari flap; Ileal substitution; Laparoscopy; Gynaecology.

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