Laparoscopic radical nephroureterectomy.

Because of the high rate of ipsilateral multifocal disease and the low incidence 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 techniques. The difficult concept has always been handling of the distal ureter and bladder cuff. A technique involving transvesical laparoscopy-assisted transurethral dissection with low pressure that mimics the open procedure 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 higher than that of the open procedure by about 24%, this figure does not include the societal costs of the longer convalescence after the latter operation. Longer follow-up will be required to learn whether the laparoscopic method is as effective from an oncologic standpoint as open surgery.