title: Retroperitoneal approach for laparoscopic nephroureterectomy with stripping technique: extracorporeal ligation of ureter and ureteral catheter.
abstract: BACKGROUND
  The pluck and stripping techniques are used for lower ureter management in renal pelvic cancer patients. Herein, we report our experience of extracorporeal ligation of the ureter and the ureteral catheter through the trocar port, which differs from conventional laparoscopic ligation in the retroperitoneal space. This technique was selected to reduce the time needed for ureter management using the stripping technique and to provide secure ligation.
  
  
  METHODS
  We performed this stripping technique in patients with T1 and T2 stage renal pelvic cancer without imaging-evident lymph node metastasis. After transurethrally placing a ureteral catheter, we resected the circumference of the ureteral orifice. After laparoscopic nephrectomy via a retroperitoneal approach, the ureteral catheter and distal ureter were ligated extracorporeally. The catheter was pulled to invaginate the ureter so it could then be pulled through the external urethral orifice.
  
  
  CONCLUSIONS
  This technique of extracorporeal ligation ensures more a secure ligation of the ureter and ureteral catheter. This modified stripping technique does not require lower ureter management with laparotomy, and it is also useful in shortening the operative time. This method is effective for relatively early stage renal pelvic cancer.
authors: Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan. kogenaka@aichi-med-u.ac.jp
authors: K
authors: K
authors: Nakamura
authors: D
authors: D
authors: Nagata
authors: K
authors: K
authors: Kajikawa
authors: I
authors: I
authors: Kobayashi
authors: K
authors: K
authors: Zennami
authors: G
authors: G
authors: Nishikawa
authors: T
authors: T
authors: Yoshizawa
authors: M
authors: M
authors: Tobiume
authors: S
authors: S
authors: Aoki
authors: Y
authors: Y
authors: Yamada
authors: M
authors: M
authors: Sumitomo
mesh_terms: D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D012187:Retroperitoneal Space; D014513:Ureter / Q000601:surgery*; D062885:Urinary Catheters