A Novel Technique for the Distal Ureter and Bladder Cuff During Nephroureterectomy: Thulium Laser Resection

ABSTRACT The aim of this study was to evaluate the safety and feasibility of a novel technique involving the use of the two‐micron thulium fibre laser (Tm‐laser) to perform bladder cuff excision (BCE) during radical nephroureterectomy (RNU). We conducted a retrospective review of all patients undergoing RNU with BCE for upper tract urothelial carcinoma at National Capital Private Hospital, Garran, 2605, Australia, between March 2010 and August 2019. Patient demographic, peri‐operative and oncologic outcome data were collected. Data analysis was performed using SPSS Statistics v27.0. Twenty‐four patients underwent nephroureterectomy with the use of Tm‐laser assistance for BCE. Of these, 80% were performed with laparoscopic and 20% with robotic assistance. The mean operative time in this cohort was 199.75 min and length of stay 7.58 days. The mean blood loss in this cohort was 149.41 mL. In all, 66.6% ( n = 16) patients had high‐grade disease, and the majority of patients had T2 or greater disease ( n = 13). With a mean follow‐up of 7.38 years, there were two cases of intravesical cancer recurrence and three cases of progression to metastatic disease. There were eight patient deaths in this cohort, three related to cancer progression. All patients had negative surgical margins. The use of Tm‐laser to assist BCE during nephroureterectomy is a safe and feasible surgical technique with sound peri‐operative safety outcomes in this small retrospective case series. Owing to the properties of the Tm‐laser, it may confer intra‐operative advantages in terms of haemostasis and vision during BCE. However, future prospective studies are required to validate these findings and cement the role of Tm‐laser during BCE.