Objectives
To describe and demonstrate our novel en bloc enucleation technique for the endoscopic
diagnosis and treatment of upper tract tumors.
Methods
We detail the instruments required for this procedure, as well as the surgical technique
to perform an en bloc enucleation and specimen removal. Endoscopic video of a 2cm
renal pelvis tumor demonstrates all aspects of the technique, and histopathologic
slides illustrate the diagnostic information obtained.
Results
A ureteral access sheath is inserted distal to the upper tract tumor, and a flexible
ureteroscope is used to visualize the extent of upper tract disease and tumor characteristics.
A 200μm thulium fiber laser partially ablates the tumor surface to create an edge
for tissue biopsy and post-ablation urine cytology. The tumor base is identified and
the subepithelial connective tissue is carefully entered with low ablation laser settings.
The correct tissue plane is extended by maintaining the ureteroscope in the subepithelial
connective tissue and continuing the dissection along the entire width of the tumor
base. Once the tumor is enucleated, a Nitinol stone retrieval basket is used to remove
the specimen(s) and a ureteral stent is placed.
Conclusions
En bloc enucleation may provide extensive histopathologic information in upper tract
urothelial carcinoma. In cases where complete enucleation is not feasible, this procedure
may afford a mechanism for large caliber biopsies.
Key Words
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References
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Article info
Publication history
Accepted:
January 4,
2023
Received:
October 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
