There have been numerous attempts to improve the surgical technique for nephroureterectomy during the last 15 years. There is mounting evidence that a laparoscopic approach can provide comparable outcomes to a conventional open incision for completion of the nephrectomy portion of the procedure. Management of the distal ureter, however, remains controversial, with numerous authors describing novel techniques and instrumentation. For optimal results, there are 2 main oncological principles to which these techniques should adhere: complete excision of the urothelium at risk for cancer recurrence,including the intramural ureter and potentially the "landing zone" within the bladder, and prevention of cancer cell-laden urinary spillage from the affected renal unit.
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