A Sealed Laparoscopic Nephroureterectomy: A New Technique

Alexander Tsivian*, Shalva Benjamin, A. Ami Sidi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To describe a purely laparoscopic nephroureterectomy approach that avoids the disadvantages of transurethral bladder cuff excision and open/laparoscopic distal ureterectomy using the EndoGIA. Methods: A standard transperitoneal laparoscopic nephrectomy is carried out through three or four ports in the flank. The ureter is dissected caudally into the pelvis. Two additional (5- and 10-mm) trocars are placed in the ipsilateral lower abdomen. Caudal ureteral dissection continues until the detrusor muscle fibers at the ureterovesical junction are identified. A 1-cm area of bladder adventitia around the ureterovesical junction is cleared. The ureter is retracted upward and laterally, tenting up the bladder wall. The bladder cuff is excised using a 10-mm LigaSure Atlas and detached from the bladder. A 6-cm lower-quadrant incision is used to remove the specimen in an Endocatch bag. An indwelling 16F Foley catheter is then placed. Results: Thirteen adult patients with suspected upper-tract transitional cell carcinoma underwent this surgical technique (operative time: 170-270 min): none had local recurrence, and two had recurrence remote from the bladder cuff scar (follow-up: 1-23 months). Conclusions: The described procedure adheres strictly to oncologic principles (removal of the affected renal unit without opening the urinary tract), and circumvents the need for transurethral/intraureteral instrumentation and patient repositioning.

Original languageEnglish
Pages (from-to)1015-1019
Number of pages5
JournalEuropean Urology
Volume52
Issue number4
DOIs
StatePublished - Oct 2007
Externally publishedYes

Keywords

  • Distal ureterectomy
  • Laparoscopy
  • Nephroureterectomy
  • Transitional cell carcinoma

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