Laparoscopic nephroureterectomy for upper tract transitional-cell cancer: technical aspects

Standard surgical therapy for most patients with upper tract transitional-cell carcinoma (TCC) is total nephroureterectomy with excision of an ipsilateral cuff of bladder; this procedure is performed through two separate or one long abdominal incision. The laparoscopic approach has the same goals. At Washington University, our approach has been similar to the open operation in that the procedure is performed transperitoneally and a cuff of bladder is secured. Herein, our current method for laparoscopic nephroureterectomy is described and illustrated in detail. In addition, other laparoscopic techniques for performing the nephrectomy portion and handling the distal ureter are described. Overall, this technique is still evolving as laparoscopic surgeons attempt to balance the goal of a thorough nephroureterectomy with the need to make the procedure cost effective.