Retrograde intra-vesical reconstructive surgery (RIVRS): A novel technique

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Radical nephrectomy with en bloc distal ureter resection is standard for upper tract transitional cell carcinoma (TCC).
• Managing the lower ureter, particularly the ureteral orifice, presents surgical challenges.

Purpose of the Study:

• To describe a novel combined endoscopic and laparoscopic technique for managing the distal ureter during radical nephrectomy for TCC.
• To demonstrate the feasibility and oncological safety of this minimally invasive approach.

Main Methods:

• Laparoscopic radical nephrectomy with lower ureter dissection.
• Endoscopic scoring of the ureteral orifice using a nephroscope.
• Transurethral suturing of the bladder defect with a specialized device passed through the nephroscope.

Main Results:

• Successful laparoscopic nephrectomy and lower ureter dissection.
• Feasible endoscopic management of the ureteral orifice and bladder closure.
• Oncological principles were maintained throughout the procedure.

Conclusions:

• The described technique offers a viable endoscopic and laparoscopic solution for distal ureter management in TCC.
• This novel approach allows for intra-mural resection and primary endoscopic closure of the bladder defect.
• Minimally invasive management of the lower ureter in TCC is achievable without compromising oncological safety.