[Laparoscopic nephroureterectomy for upper urinary tract urothelial tumors]

We present our 11 year experience with 15 laparoscopic nephroureterectomy procedures for upper urinary tract urothelial tumor.

The tumor site was pyelocalyceal in 9 cases, ureteral in 4, and multifocal in one. All cases were urothelial tumors grade II or III; stage was Ta-T1 in 9 cases, T2 in three, T3 in two, and T4 in one. Transperitoneal approach was performed in 14 cases, whereas only one retroperitoneal. Hand assisted laparoscopy was performed in five cases. Seven specimens were extracted after morcellation without any recorded tumor seeding attributable to this manoeuvre. We recorded one case of sudden death due to pulmonary embolism 48 hours after the procedure, one case of intestinal obstruction secondary to an ileal loop hernia through the parietal orifice of one of the trocars, and one case of unstable angina pectoris. Two patients died because of disease progression, one of them after bladder recurrence.

We think that hand assisted laparoscopy is a good indication for nephroureterectomy for upper urinary tract urothelial tumor. We propose a new procedure to avoid possible tumor cell spilling at the time of ureterectomy, which simplifies the operation very much at the same time.