INTRODUCTION: We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized. MATERIALS: From 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy. RESULTS: The mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all - mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months. CONCLUSION: CLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder.

Department of Pathology Charles University Hospital Pilsen Czech Republic

Department of Pathology Charles University Hospital Pilsen Czech Republic ; Department of Pathology National University Health System Singapore

Department of Urology Charles University Hospital Pilsen Czech Republic

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Clayman RV, Kavoussi LR, Figenshau RS, et al. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg. 1991;1(6):343–349. PubMed

Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol. 2009;56:1–9. PubMed

Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010;57(6):963–969. PubMed

Shalhav AL, Dunn MD, Portis AJ, et al. Laparoscopic nephroureterectomy for upper tract transitional cell cancer: the Washington University experience. J Urol. 2000;163(4):1100–1104. PubMed

Matin SR, Gill IS. Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control. J Urol. 2005;173:395–400. PubMed

Macejko AM, Pazona JF, Loeb S, et al. Management of distal ureter in laparoscopic nephroureterectomy-a comprehensive review of techniques. Urology. 2008;72(5):974. PubMed

Tsivian A, Benjamin S, Sidi AA. A sealed laparoscopic nephroureterectomy: a new technique. Eur Urol. 2007;52:1015–1019. PubMed

Simone G, Papalia R, Leonardo C, et al. Laparoscopic versus open nephroureterectomy: comparison of operative data and preliminary results of oncological outcome. Eur Urol Suppl. 2007;6:221. (Abst. 793)

Simone G, Papalia R, Guaglianone S, et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomized prospective study. Eur Urol. 2009;56:520–526. PubMed

Hora M, Stránský P, Eret V, et al. Complete laparoscopic nephroureterectomy with thermo-sealing system. CEJU. 2010;63(2):77–81.

Hemal AK, Kumar A, Gupta NP, Seth A. Retroperitoneal nephroureterectomy with excision of cuff of the bladder for upper urinary tract transitional cell carcinoma: comparison of laparoscopic and open surgery with long-term follow-up. World J Urol. 2008;26(4):381–386. PubMed

Hattori R, Yoshino Y, Komatsu T, et al. Pure laparoscopic complete excision of distal ureter with a bladder cuff for upper tract urothelial carcinoma. World J Urol. 2009;27(2):253–258. PubMed

Cho HJ, Kim SJ, Yoon BI, et al. A Novel Bulldog Clamp Technique for Management of a Distal Ureter and Bladder Cuff During Laparoscopic Nephroureterectomy. J Endourol. 2010;24(11):1719–1720. PubMed

Shoma AM. Purse-string technique for laparoscopic excision of a bladder mucosal cuff in patients with transitional cell carcinoma of the upper urinary tract: initial report with intermediate follow-up. BJU Int. 2009;104:1505–1509. PubMed

Ghazi A, Shefler A, Gruell M, et al. A Novel Approach for a Complete Laparoscopic Nephroureterectomy with Bladder Cuff Excision. J Endourol. 2010;24(3):415–419. PubMed

Gill IS, Soble JJ, Miller SD, Sung GT. A novel technique for management of the en bloc bladder cuff and distal ureter during laparoscopic nephroureterectomy. J Urol. 1999;161:430–433. PubMed

Agarwal DK, Khaira HS, Clarke D, Tong R. Modified transurethral technique for the management of distal ureter during laparoscopic assisted nephroureterectomy. Urology. 2008;71:740–743. PubMed

Pathak S, Watcyn-Jones T, Lavin V, et al. A novel closed system laparoscopic nephroureterectomy for upper tract urothelial cancer. J Urol. 2008;179(Suppl 4):159A.

Pathak S, Watcyn-Jones T, Doyle D, Oakley N. Laparoscopic nephro-ureterectomy for upper tract urothelial cancer: cystoscopic closed system pluck. Ann R Coll Surg Engl. 2008;90(6):524–525. PubMed PMC

Sesmero JH, Redondo CC, Delgado MC, et al. Intravesical sealing of the distal ureter in nephroureterectomy. Arch Esp Urol. 2010;63(3):223–229. PubMed

Mueller T, DaJusta D, Cha D, et al. Ureteral Fibrin Sealant Injection of the Distal Ureter During Laparoscopic Nephroureterectomy - A Novel and Simple Modification of the Pluck Technique. Urology. 2010;75(1):187–192. PubMed

Hora M, Eret V, Ürge T, et al. Antegrade miniinvasive nephroureterectomy (AMNUE - laparoscopic nephrectomy, transurethral excision of ureterovesical junction and lower abdominal incision) Urol Int. 2009;83(3):264–270. PubMed

Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications. A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004;240(2):205–213. PubMed PMC

Park SY, Neony W, Ham WS, et al. Initial experience of robotic nephroureterectomy: a hybrid-port technique. BJU Int. 2009;104(11):1718–1721. PubMed

Hu JC, Silletti JP, Williams SB. Initial experience with robot-assisted minimally-invasive nephroureterectomy. J Endourol. 2008;22(4):699–704. PubMed

Guzzo TJ, Schaeffer EM, Allaf ME. Laparoscopic Radical Nephroureterectomy With En-Bloc Distal Ureteral and Bladder Cuff Excision Using a Single Position Pneumovesicum Method. Urology. 2008;72:850–852. PubMed

Sotelo R, Ramírez D, Carmona O, et al. A novel technique for distal ureterectomy and bladder cuff excision. Actas Urol Esp. 2011;35(3):168–174. PubMed

Ahlawat RK, Gautam G. Suprapubic transvesical single-port technique for control of lower end of ureter during laparoscopic nephroureterectomy for upper transitional cell carcinoma. Indian J Urol. 2011;27(2):190–195. PubMed PMC

Ürge T, Hes O, Ferda J, et al. Clinical characteristics of oncocytic papillary renal cell carcinoma. World J Urol. 2010;28(4):513–517. PubMed