[A novel technique for distal ureterectomy and bladder cuff excision]

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncology

Background:

• Radical nephroureterectomy is the standard treatment for upper tract urothelial carcinoma.
• Management of the distal ureter and bladder cuff remains a challenge in minimally invasive surgery.
• A literature review was conducted to contextualize the novel approach.

Observation:

• A novel endoscopic technique utilizing a single transvesical port and pneumovesicum was employed.
• The procedure involved laparoscopic dissection of the ureter to the bladder, followed by transvesical mobilization and en bloc excision of the distal ureter and bladder cuff.
• The specimen was delivered laparoscopically.

Findings:

• The described procedure was successfully performed on an 80-year-old male with renal pelvic TCC.
• The total operating time was 6 hours and 15 minutes, with 45 minutes dedicated to bladder cuff excision.
• No intraoperative or postoperative complications were observed, and the patient recovered well.

Implications:

• This single-port transvesical approach is a feasible option for en bloc dissection of the distal ureter and bladder cuff.
• Standardization of techniques for distal ureter management during laparoscopic nephroureterectomy is still needed.
• Further research is required to establish the optimal approach for this complex surgical step.