A sealed laparoscopic nephroureterectomy: a new technique.
OBJECTIVE
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.
Tsivian
Alexander
A
Department of Urologic Surgery, Wolfson Medical Center, Holon, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. atsivian@hotmail.com
Benjamin
Shalva
S
Sidi
A Ami
AA
D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*