LAPAROSCOPIC NEPHROURETERECTOMY - MAKING MANAGEMENT OF UPPER-TRACT TRANSITIONAL-CELL CARCINOMA ENTIRELY MINIMALLY INVASIVE

Endoscopic treatment of upper-tract transitional-cell carcinoma (TCC) is well established, Nevertheless, many patients still required major ablative surgery. We have applied our experience with laparoscopic nep hrectomy to the performance of laparoscopic nephroureterectomy in orde r to make the management of upper-tract TCC entirely minimally invasiv e, Since 1993, we have performed 22 laparoscopic nephroureterectomies for upper-tract TCC, Initially, we excluded patients with tumors below the pelvic brim, but we now offer a trial of laparoscopy to all patie nts. We describe the evolution of our technique, which involves resect ing the ureteral orifice prior to laparoscopic dissection of the kidne y and ureter, We have had to convert three cases to open surgery, one each for bleeding, failure to progress, and unappreciated tumor extent , Operative times averaged 156 minutes, which compares well with conte mporary times for open nephroureterectomy, Complication rates, transfu sion requirements, and length of stay, although higher than those of l aparoscopic nephrectomy, were all reduced in comparison with open neph roureterectomy.