UROLOGICAL SURVEY
Urological oncology
Port site metastases in urological laparoscopic surgery
Tsivian A, Sidi AA
Department of Urologic Surgery, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Holon, Israel
J Urol. 2003; 169: 1213-8
PURPOSE: Laparoscopic surgery is rapidly gaining widespread acceptance among urologists, including extensive application in malignant conditions. However, untoward occurrences of port site metastases have not eluded to urological applications. This up-to-date review on port site metastases in urology delineates possible contributing factors and describes techniques to prevent it.
MATERIALS AND METHODS: We comprehensively reviewed published experimental and clinical studies with special emphasis on the incidence, pathophysiology and prevention of port site metastases.
RESULTS: Nine cases of port site metastases after urological laparoscopy have been described in clinical and experimental studies. Etiological factors include natural malignant disease behavior, host immune status, local wound factors, laparoscopy related factors such as aerosolization of tumor cells (the use of gas, type of gas, insufflation and desufflation, and pneumoperitoneum) and sufficient technical experience of the surgeons and operating team (adequate laparoscopic equipment, skill, minimal handling of the tumor, surgical manipulation and wound contamination during instruments change, organ morcellation and specimen removal).
CONCLUSIONS: Port site metastases is a multifactorial phenomenon with an as yet undetermined incidence. The problem is influenced to some extent by surgeon and operating team experience and, therefore, it could be partially prevented. The suggested preventive steps are avoiding laparoscopic surgery when there are ascites, trocar fixation to prevent dislodgment, avoiding gas leakage along and around the trocar, sufficient technical readiness of the operating team (adequate laparoscopic equipment and technique, minimal handling and avoiding tumor boundary violation of the tumor), using a bag for specimen removal, placing drainage when needed before desufflation, povidone-iodine irrigation of instruments, trocars and port site wounds, and suturing 10 mm. and larger trocar wounds.
Editorial Comment
This thorough review describes a rare but existent event in laparoscopy of urological tumors, metastases in the port tract. The authors analyzed the published literature on incidences of port site metastases and (only) found 9 cases. They conclude, that the real incidence of a port site metastases is yet undetermined (that is, many might be falsely referred to as local recurrences of the tumor).
Factors to prevent port site metastases are analyzed and specified in detail. Further to the data given in my one analysis of the data, 1 important point became obvious: 5 of the 9 cases described were transitional cell carcinomas. With the background of the known implantation rate in transurethral resection of superficial bladder tumors, this tumor entity might not be the ideal indication for a laparoscopic approach. Certainly further research on this phenomenon is necessary.
Dr. Andreas Böhle
Professor and Vice-Director of Urology
Medical University of Luebeck
Luebeck, Germany
Publication Dates
-
Publication in this collection
26 Jan 2004 -
Date of issue
June 2003
