Retroperitoneal laparoscopic nephroureterectomy and management options forthe distal ureter

Radical nephroureterectomy, including en bloc excision of the ureter with a bladder cuff, is the standard treatment for upper tract transitional-cell carcinoma (TCC), This procedure requires either a flank and lower abdominal incision or an extended flank incision, Laparoscopic surgery for TCC has b een used at several medical centers; the most challenging and controversial aspect is the oncologically correct management of the distal ureter, We be lieve that the Cleveland Clinic technique of securing the distal bladder cu ff intravesically while simultaneously occluding the distal ureter prevents tumor spillage and allows accurate and complete resection of the targeted ureter in a manner mirroring the open procedure.