Pure laparoscopic complete excision of distal ureter with a bladder cuff for upper tract urothelial carcinoma

In laparoscopic nephroureterectomy for upper tract urothelial carcinoma techniques for removing the lower ureter with a bladder cuff have been a matter of debate. We have developed a pure laparoscopic technique for the complete resection of the lower ureter with a bladder cuff. Laparoscopic nephroureterectomy was performed in ten patients with upper tract urothelial carcinoma using this technique. After a working space was made retroperitoneally, the ureter was ligated at the distal site of the tumor. Retracting the ureter cranially, a stay suture was placed at an anterior point on the bladder and the bladder opened. With the patient placed in a lateral position, there was no urine leakage from the opened bladder. The ureteral orifice was confirmed laparoscopically. Incising around the ureteral orifice, the distal ureter was detached with the bladder cuff. The opened bladder wall was closed with running stitches. This method was technically successful in these ten cases with minimal bleeding and average operative time of 87 min. The margins of the bladder cuff were all negative and the average follow-up period of 19 months revealed only one (10%) bladder tumor recurrence. The ligation of the distal part of the ureter and the complete excision of the ipsilateral orifice and a bladder cuff under laparoscopic vision could reduce bladder tumor recurrence. Although this is a limited study with a small sample, the observation of low rates of bladder tumor recurrence after 19 months warrants further study.