title: Complete laparoscopic nephroureterectomy with intravesical lockable clip.
abstract: BACKGROUND
  We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized.
  
  
  METHODS
  From 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy.
  
  
  RESULTS
  The mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all - mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months.
  
  
  CONCLUSIONS
  CLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder.
authors.affiliation: Department of Urology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.affiliation: Department of Urology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Viktor
authors.initials: V
authors.lastname: Eret
authors.affiliation: Department of Urology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Urge
authors.affiliation: Department of Urology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Klečka
authors.affiliation: Department of Urology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Trávníček
authors.affiliation: Department of Pathology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Hes
authors.affiliation: Department of Pathology, Charles University Hospital, Pilsen, Czech Republic ; Department of Pathology, National University Health System, Singapore.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Petersson
authors.affiliation: Department of Urology, Charles University Hospital, Pilsen, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Stránský
keywords: laparoscopy; nephrectomy; ureter; urothelial carcinoma