Totally Minimally Invasive Laparoscopic Nephroureterectomy; A Hand-Crafted Loop Ligation Technique of the Distal Ureter

Introduction and Objective:

We present a reproducible and cost-effective endoscopic technique for the management of the distal ureter and ureteric orifice during a laparoscopic nephroureterectomy. To achieve the best outcomes, this requires a balance of early control of the ureteric orifice, maintaining a totally minimally invasive approach, and avoiding tumor spillage.

Method:

We use a T6 ureteric catheter and prolene 2/0 suture to create the looping device. Once the ureteric orifice has been circumscribed using a Collin’s knife, we ligate the ureteric stump using the looping device through a cystoscope.

Results:

The technique is reproducible in four cases. There were no perioperative complications. We found it to be significantly cheaper when compared to a commercially available looping device.

Conclusion:

The hand-crafted loop ligation technique is a reproducible and cost-effective technique that is safe and achieves early control of the distal ureter to avoid tumor spillage.

Author Disclosure Statement:

No competing financial interests exist. The author has received and archived patient consent for video recording/publication in advance of the video recording of the procedure.

Funding Information:

No funding was received for this article.

Video duration: 6 mins 1 secs. 2025