This review of an article by one of the founders of laparoscopic urology shows that with one of the common laparoscopic method to remove a kidney, ureter, and bladder cuff for transitional cell caner of the upper urinary tract lining there seems to be a higer recurrence rate and positive margins.
Our current technique is a robotic approach to remove the whole specimen intact with 2 robotic operations at the same setting. Prior to this I usually would remove the kidney with the laparoscope and then the ureter and bladder cuff with an open incision. Without robotic surgery, I never felt that I would obtain as good a specimen as with open surgery for the bladder part of the operation. With the robotic nephroureterectomy, I think the specimen is equal and there is no need to make a large incision or to open up the bladder like I did in open surgery.
Oncologic Outcomes of Extravesical Stapling of Distal Ureter in Laparoscopic Nephroureterectomy
The local recurrence rate (17% vs. 0%) and the bladder recurrence rate (50% vs. 33%) were higher in the laparoscopic stapled group (p = 0.090)
Of note there were 3 patients (25%) with a positive margin in the laparoscopic group vs. none in the open group.
To be sure, as a frequent user of the stapler to remove the ureteral cuff, I have over the years altered my technique in order to improve removal of a larger cuff of bladder along with the entire ureteral tunnel:
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