How laparoscopic surgery is performed

  The traditional surgical approach for treating renal pelvic/ureteral cancer is total nephroureteral resection, which requires 2 incisions or 1 long incision. Percutaneous nephrological and ureteroscopic procedures are only suitable for the treatment of some superficial tumors.  Laparoscopic radical surgery for renal pelvic/ureteral cancer can be performed by either the transabdominal or retroperitoneal route. The retroperitoneal approach can avoid interference with the abdominal organs while dealing with the renal head vessels more quickly; however, retroperitoneal surgery has a risk of tumor dissemination due to perforation of the renal pelvis during surgical separation if the patient has severe hydronephrosis because of the narrow space for retroperitoneal operation, while partial laparoscopic cystectomy via retroperitoneum It is also difficult to remove the end of the ureter.  The management of the ureteral end during laparoscopic radical surgery for pyel/ureteral cancer has been reported in the literature in different ways. The cystoscopic loop resection of the ureteral orifice is simpler, but the severed ureteral orifice may lead to retroperitoneal tumor implantation; the gastrointestinal cutter closure with central closure of the intramural ureteral segment along with part of the bladder requires a large space separation, and there is a risk of local tumor recurrence due to the residual intramural ureteral segment after surgery, and the retention of titanium staples in the bladder wall may also lead to stones; Gill et al. reported that the ureteral orifice was first clamped via the bladder to avoid tumor implantation. Gill et al. reported that the ureter was first clamped via the bladder to avoid tumor implantation, but the surgical steps were cumbersome; small lower abdominal incisions to remove the terminal ureter required changing the surgical body and making another incision.  We used complete laparoscopic surgery (partial nephroureteral cystectomy) via the transabdominal route to treat ureteral cancer of the renal pelvis, which removed the kidney and ureter on the side of the lesion and, like the classic open surgical approach, ensured complete removal of the inner segment of the ureteral bladder wall and reduced the chance of tumor recurrence; there was no need for another lower abdominal incision, and the surgery was less invasive and the patient’s hospital stay was shorter.