Laparoscopic nephroureterectomy for TCC of the ureter or renal pelvis

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.

clipped from

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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