Laparoscopic Pluck Technique

The "pluck" method was adopted by Keeley and Tolley (14). The authors performed 25 laparoscopic nephroureterectomy in this fashion with a mean follow-up of 32.9 months (15). Sixteen percent of the patients had died of the disease, and the bladder/retroperitoneal recurrence rates were not reported. As mentioned previously, because the ureteral orifice is not occluded during transurethral resection, the retroperitoneum near the resected orifice may be seeded during the nephrectomy by tumor-laden urine. Furthermore, because the distal ureter is not marked, i.e., with suture or clip, it is difficult to assess whether the entire ureter with its bladder cuff is removed when it is plucked.

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