Laparoscopic radical nephroureterectomy

Because of the high rate of ipsilateral multifocal disease and the low inci dence of contralateral disease, upper tract transitional-cell carcinoma has historically been treated with radical nephroureterectomy, This operation has been performed laparoscopically in many medical centers, with various t echniques. The difficult concept has always been handling of the distal ure ter and bladder cuff. A technique involving transvesical laparoscopy-assist ed transurethral dissection with low pressure that mimics the open procedur e is used at the Cleveland Clinic. The reported mean operative times range from 2.6 to 8.3 hours, with the longest time being reported from one of the earliest series. Although the cost of laparoscopic nephroureterctomy is hi gher than that of the open procedure by about 24%, this figure does not inc lude the societal costs of the longer convalescence after the latter operat ion. Longer follow-up will be required to learn whether the laparoscopic me thod is as effective from an oncologic standpoint as open surgery.