Agarwal PolyLoop Ligation Technique for the Management of the Distal Ureter during Laparoscopic Assisted Nephroureterectomy.

Objective: Management of the distal ureter during radical nephroureterectomy remains a controversial issue. This article describes a simple endoscopic PolyLoop ligation technique for managing the distal ureter during radical nephroureterectomy.

Methods: This endoscopic technique was used in 6 cases to manage the distal ureter during laparoscopic-assisted radical nephroureterectomy. The distal ureter with en bloc bladder cuff was managed endoscopically. The distal ureteric orifice with 1 cm bladder cuff was circumscribed using a Collins knife. Commercially available, Olympus detachable PolyLoop was used to ligate the ureteric stump to avoid urine spillage from the upper tract. Once ureteric stump was ligated with a PolyLoop, the distal ureter was mobilized by dividing the periureteric adhesions using a Collins knife.

Results: Distal ureter was managed successfully in all 6 cases using commercially available detachable Polyloop from Olympus. There were no perioperative complications relating to this technique.

Conclusions: The PolyLoop ligation technique offers a simple and safer alternative to manage the distal ureter during radical nephroureterectomy.