Complete laparoscopic nephroureterectomy with intravesical lockable clip

Milan Hora¹, Viktor Eret¹, Tomáš Ürge¹, Jiří Klečka¹, Ivan Tránvíček¹, Ondřej Hes², Fredrik Petersson ²,³, Petr Stránský¹

Charles University Hospital, Pilsen, Czech Republic, Department of ¹Urology and ²Pathology

³Department of Pathology, National University Health System, Singapore


Introduction: We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomised.

Materials: From 1/2010 to 1/2012, 21 patients were subjected to CLNUE- IVLC. The first step was transurethral excision of the ureterovesical junction with Collin’s knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. Clip on the distal ureter if proof of completion of ureterectomy.

Results: The mean operation time was 161 (115-200) min. In four (19.0%) the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision which was also used for extraction of specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all – mean 10.6 (range: 0-25) months. One died for generalisation in 11 months.

Conclusion: CLNUE- IVLC is a fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages: need to change the position of the patient, risk of inability to apply the clip on the distal ureter, unclosed defect of the urinary bladder.