A novel approach for a complete laparoscopic nephroureterectomy with bladder cuff excision

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Management of the distal ureter and bladder cuff in nephroureterectomy (NU) for upper urinary tract transitional-cell carcinoma (TCC) presents a surgical challenge.
• This has historically limited the development of completely minimally invasive NU approaches for TCC.

Purpose of the Study:

• To present a purely laparoscopic NU technique performed entirely through laparoscopic ports.
• This technique aims to replicate open surgical principles, including bladder cuff excision, without patient repositioning or additional endoscopic procedures.

Main Methods:

• A standard laparoscopic radical nephrectomy setup was used, with an additional 5 mm trocar in the lower abdomen.
• This allowed for dissection of the distal ureter, bladder cuff excision, and watertight closure of the bladder defect.
• No transurethral or intraureteral instrumentation or patient repositioning was required.

Main Results:

• Eight patients underwent the procedure successfully.
• Operative time averaged 157 minutes (range 110-200 min).
• Median catheter removal was 7 days, with one case delayed to 15 days due to bladder extravasation. Mean follow-up was 12.1 months, with 4 recurrences (3 Ta bladder, 1 local).

Conclusions:

• Complete laparoscopic nephroureterectomy with bladder cuff excision is feasible.
• Early results are comparable to open surgery.
• The addition of a single laparoscopic trocar facilitates this minimally invasive approach.