Complete laparoscopic nephroureterectomy with thermo-sealing system

Abstract

Introduction. We present our opinions with complete laparoscopic nephroureterectomy (CLNUE) using a thermo-sealing device and a main disadvantage of this technique. Material and method. From 4/2008 to 12/2009, 19 CLNUEs were performed. Standard laparoscopic nephrectomy (NE) is followed by laparoscopic liberation of ureter which is divided from urinary bladder with bladder cuff by Ligasure® Atlas. results. The mean time was 126 (86-160) min, blood loss 58 (0-200) ml. On one woman, a CLNUE was performed ipsilaterally on a transplanted kidney. There was only one complication: a urinary tract infection with E. coli. The mean hospital stay was 6.7 (3 to 11) days. Follow-up is known in all patients – mean 11 (1-25) months. The results of the check-up endoscopy are known in 14 cases and in six an intact ureteral orifice was found, which corresponds to insufficient excision of the orifice. Conclusion. CLNUE is a fast and safe surgery. There is a significant risk to the remaining part of the intramural ureter in situ in a less radical approach to the ureterovesical junction. Due to this reason, we are looking for another more reliable method of mini-invasive NUE. CLNUE (including division of the whole ureter in the minor pelvis as well) is feasible even ipsilaterally on a transplanted kidney.