Laparoscopic approaches to transitional cell carcinomas of the upper urinary tract

Traditionally transitional cell tumors of the upper urinary tract are treated by nephroureterectomy. In circumstances where low functional renal reserve necessitates renal parenchymal preservation, endoscopic or percutaneous treatment may be an option for low grade and stage lesions. In this article, the role of laparoscopic surgery as an alternative modality to open surgery is discussed. Techniques of laparoscopic nephroureterctomy are described and different approaches (transperitoneal, retroperitoneal, and gasless hand-assisted) are contrasted. The limitations imposed on laparoscopic treatment by the requirement of adherence to oncological principles of tumor containment and excision of the intramural ureter, are outlined. Laparoscopic nephroureterectomy, although technically demanding, has been shown to be a feasible procedure. Benefits of the laparoscopic approach include shortened hospital stay and early return to daily activities. It is unclear at this time whether these immediate advantages over open surgery will yield comparatively efficacious long term outcomes.