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Fig. 3 | World Journal of Surgical Oncology

Fig. 3

From: Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

Fig. 3

Procedure of transvesical laparoscopic bladder cuff excision. a Postoperative wound for the suprapubic three ports is shown (black arrows). The bladder was distended with 400–500 mL of saline. A total of three 5-mm trocars were placed at the bladder dome and on both sides of the lateral wall of the distended bladder under cystoscopy guidance. A 3-0 monofilament traction suture is passed percutaneously through the bladder walls to prevent the bladder wall from falling away from the abdominal wall. b A 4-cm-long segment of an 8Fr pediatric feeding tube is inserted into the ipsilateral ureter to facilitate ureteral mobilization and dissection and secured by a 5-zero monofilament suture. c Circumscribing ureteral orifice and mobilizing ureter using fine 3-mm endoscopic scissors. d Traction on the ureteric catheter and cut of fibrovascular tissue surrounding the ureter to free it. e The ureter is pushed back to the retroperitoneal space. f The muscular defect and mucosal defect in the ureteral hiatus are sutured intravesically using 5-zero absorbable monofilament sutures, usually with an extracorporeal knot-tying technique. g Complete suturing of the bladder wall defect

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