title: [A novel technique for distal ureterectomy and bladder cuff excision].
abstract: BACKGROUND
  We describe a novel endoscopic approach and provide a literature review for the "en bloc" dissection of the distal ureter and bladder cuff during laparoscopic radical nephroureterectomy using a transvesical single port approach under pneumovesicum.
  
  
  METHODS
  The procedure was performed in an 80-year old male with a history of gross hematuria due to left renal pelvic TCC and no history of prior bladder TCC. Laparoscopic radical nephroureterectomy was performed and the ureter was dissected down to the bladder and clipped. A single-port device was inserted transvesically and pneumovesicum established. A full thickness incision of the bladder around the ureter was performed with progressive intravesical mobilization of the distal ureter. Subsequently, a water-tight closure of the bladder defect was achieved. The distal ureter, together with the bladder cuff, was then delivered en bloc laparoscopically with the specimen.
  
  
  RESULTS
  The operating time (LESS radical nephroureterectomy, RPLND, and bladder cuff excision) was 6hours and 15minutes. The bladder cuff time was 45minutes. There were no intra or postoperative complications and the catheter was removed after 6 days. Histopathological analysis showed kidney-invasive papillary urothelial cancer, pT3 pN0 (0/7) G3.
  
  
  CONCLUSIONS
  The distal ureter and bladder cuff techniques have not yet been standardized. Management of the bladder cuff with a single port is feasible. Additional studies are needed to identify the best approach for management of the distal ureter at the time of laparoscopic nephroureterectomy.
authors.affiliation: Instituto Médico La Floresta, Caracas, Venezuela. renesotelo@cantv.net
authors.forename: R
authors.initials: R
authors.lastname: Sotelo
authors.forename: D
authors.initials: D
authors.lastname: Ramírez
authors.forename: O
authors.initials: O
authors.lastname: Carmona
authors.forename: E
authors.initials: E
authors.lastname: di Grazia
authors.forename: R
authors.initials: R
authors.lastname: de Andrade
authors.forename: C
authors.initials: C
authors.lastname: Giedelman
authors.forename: Z
authors.initials: Z
authors.lastname: Pascal
authors.forename: I
authors.initials: I
authors.lastname: Gill
authors.forename: M
authors.initials: M
authors.lastname: Desai
mesh_terms: D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods