title: Laparoscopic transvesical resection of an en bloc bladder cuff and distal ureter during nephroureterectomy.
abstract: OBJECTIVE
  The most appropriate technique for excising the distal ureter and bladder cuff during laparoscopic nephroureterectomy is still debated. We report our experience with a pure laparoscopic transvesical method that duplicates the long-standing open transvesical approach.
  
  
  METHODS
  Seven men and three women diagnosed with upper tract transitional cell carcinoma were treated with this procedure. Three intravesical ports were inserted, and pneumovesicum was established at 12 mmHg. Transvesical laparoscopic circumferential detachment of the bladder cuff and en bloc mobilization of the last centimeters of the distal ureter were performed, followed by the closure of the bladder defect. Subsequently, a nephrectomy was performed either laparoscopically or using an open flank approach.
  
  
  RESULTS
  The median age was 68.5 years. The procedure was completed uneventfully in all cases. The median operating time for distal ureter excision was 82.5 minutes (range 55-120). No complications directly related to the pneumovesicum method were recorded. The median follow-up period was 31 months (range 12-55). During the follow-up period, two patients (20%) died from the disease, and a bladder tumor developed in three cases (30%).
  
  
  CONCLUSIONS
  The laparoscopic transvesical resection of the en bloc bladder cuff and distal ureter is a reliable, effective, and oncologically safe technique, at least in the midterm.
authors.affiliation: Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece. stgian@otenet.gr
authors.forename: Stilianos
authors.initials: S
authors.lastname: Giannakopoulos
authors.forename: George
authors.initials: G
authors.lastname: Toufas
authors.forename: Charalampos
authors.initials: C
authors.lastname: Dimitriadis
authors.forename: Stavros
authors.initials: S
authors.lastname: Giannopoulos
authors.forename: Christos
authors.initials: C
authors.lastname: Kalaitzis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Bantis
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Patris
authors.forename: Stavros
authors.initials: S
authors.lastname: Touloupidis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D062666:Vascular Access Devices