Current methods of nephroureteroctomy
Authors:
M. Hora; J. Klečka; V. Eret; T. Ürge; P. Kočovská
Authors‘ workplace:
Urologická klinika LF UK a FN Plzeň
Published in:
Urol List 2007; 5(4): 83-89
Overview
Objective:
Laparoscopy has definitely gained its place in the surgical treatment of renal cancers. Laparoscopic methods can be successfully used in the treatment of upper urinary tract tumors. However, in this case we need to combine these methods with treatment of distal ureter. This article presents an overview of current methods of minimally invasive nephroureterectomy.
Discussion:
Laparoscopic nephrectomy (transperitonenal or retroperitoneal) is preferred to open techniques. Distal ureter is treated using open, endoscopic or complete laparoscopic approach (ureter is interrupted by a stapler at the level of bladder). During endoscopy the ureterovesical junction is cut by resection loop or diathermic knife. The distal ureter is subsequently blindly dissected using so called “pluck” technique or using stripping-intussusception technique. The simple pluck technique, which is associated with the risk of tumor dissemination, can be modified using occlusive balloon or using transvesical assistance of two ports enabling ureter ligation (Cleveland technique). The drawbacks of the “pluck” technique can be eliminated by the antegrade approach. This can be achieved by modified position enabling simultaneous performance of laparoscopy and endoscopy. Another option is to perform excision transvesically during hand-assisted operation after nephrectomy. A last option is laparoscopic neprectomy, rotating patient into lithotomy position, endoscopic excision and perirectal incision.
Conclusion:
Laparoscopy is currently preferred method of nephroureterectomy. The choice of the method of distal ureter treatment depends particularly on the center‘s preference. We prefer the “pluck” technique in antegrade modification. We recommend to always use the extraction sack. In patients with advanced tumors and distal ureter tumors the open surgery might be more appropriate.
Key words:
nephroureterectomy, laparoscopy, retroperitoneoscopy, transurethral resection, ureter
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