A New 2-Micrometer Continuous Wave Laser Method for Management of the Distal Ureter in Retroperitoneal Laparoscopic Nephroureterectomy

Background and Purpose: Retroperitoneal laparoscopic nephroureterectomy (LNU) is a classic technique for the treatment of patients with urothelial cancer of the upper urinary tract. Management of the distal ureter in patients undergoing this procedure remains controversial, however. We evaluated a new method involving cystoscopic sleeve resection of the distal ureter using a 2-mu m continuous wave laser before LNU. Patients and Methods: LNU was performed in 38 patients at our hospital between January 2008 and January 2012. The distal end of the ureter was managed by using a 2-mu m continuous wave laser to evaporate and excise the ureteral orifice and bladder cuff. A standard technique was applied to keep the ureter intact. The ureter was dissected to the entrance of the bladder, and the distal ureter was easily detached from the bladder. Results: The distal ureter was excised completely in all cases using this new technique. The average operative time was 2.4 hours, and the average blood loss was 69.4 mL. At 1 year after surgery, the cause-specific survival rate of the patients was 100%, the bladder recurrence-free rate was 89%, and the extravesical recurrence-free rate was 100%. Conclusions: For managing the distal ureter during LNU, the new technique described proved to be a simple, safe, and minimally invasive method.