title: [Laparoscopic nephroureterectomy: new position for the management of distal ureter].
abstract: OBJECTIVE
  The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter.
  
  
  METHODS
  Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy.
  
  
  RESULTS
  Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days.
  
  
  CONCLUSIONS
  We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today.
authors.affiliation: Servicio de Urología, Hospital Universitario La Paz, Madrid, España. aaguilera11@yahoo.es
authors.forename: Alfredo
authors.initials: A
authors.lastname: Aguilera Bazán
authors.forename: Sergio
authors.initials: S
authors.lastname: Alonso y Gregorio
authors.forename: Manuel
authors.initials: M
authors.lastname: Pérez Utrilla
authors.forename: Ramón
authors.initials: R
authors.lastname: Cansino Alcaide
authors.forename: Jesús
authors.initials: J
authors.lastname: Cisneros Ledo
authors.forename: Javier
authors.initials: J
authors.lastname: De la Peña
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011187:Posture; D014513:Ureter / Q000601:surgery*