Single surgical port transforming into a flower.

Single-Port Laparoscopic Nephroureterectomy: Is This the Future of Upper Urinary Tract Cancer Surgery?

Nico Varela in Health & Wellness July 2025 • 4 min read.

"Explore the innovative T-LESS technique for bladder cuff dissection, offering enhanced precision and recovery in kidney cancer treatment."

Laparoscopic nephroureterectomy (LNU) has become a cornerstone in treating upper urinary tract transitional cell carcinoma. The quest to refine this technique continues, focusing on how best to manage the distal ureter—the section nearest the bladder—during surgery. Traditionally, surgeons have used various approaches, yet a definitive consensus remains elusive.

One of the most promising advancements is the transvesical single-port approach, known as T-LESS. This method involves excising the distal ureter and bladder cuff—the tissue connecting the ureter to the bladder—through a single entry point in the bladder. This approach minimizes invasiveness and enhances recovery, making it an appealing option for both surgeons and patients.

A recent study published in Videosurgery Miniinv explores the initial outcomes of using T-LESS for en-bloc dissection of the distal ureter and bladder cuff during LNU. This article delves into the specifics of the technique, its benefits, and what it means for the future of kidney cancer surgery.

What is Single-Port Laparoscopic Nephroureterectomy?

Single surgical port transforming into a flower.

Single-port laparoscopic nephroureterectomy represents a significant leap forward in minimally invasive surgery for upper urinary tract cancer. Standard LNU involves removing the kidney, ureter, and a cuff of bladder tissue through several small incisions. In contrast, the single-port technique consolidates these steps through just one incision, typically in the navel, reducing visible scarring and potentially lowering post-operative pain.

The T-LESS approach takes this a step further by performing the distal ureter and bladder cuff dissection through a single port directly into the bladder. This allows for precise removal of the affected tissue while minimizing trauma to surrounding areas.

Reduced Invasiveness: Smaller incision leads to less tissue damage and scarring.
Enhanced Precision: Direct access allows for meticulous dissection and removal of cancerous tissue.
Faster Recovery: Patients typically experience shorter hospital stays and quicker return to normal activities.
Improved Cosmesis: Single incision results in a less noticeable scar.

The Videosurgery Miniinv study detailed the outcomes of five patients undergoing LNU with T-LESS. The results indicated that all procedures were completed successfully without significant blood loss or complications. The average operative time for the T-LESS stage was just under an hour, and patients experienced a relatively short postoperative hospital stay.

The Future of Kidney Cancer Surgery

Single-port laparoscopic nephroureterectomy, particularly with the T-LESS approach, holds considerable promise for the future of upper urinary tract cancer surgery. As techniques continue to evolve and more data become available, it's likely that this minimally invasive approach will become increasingly prevalent, offering patients a less traumatic and more effective treatment option.

About this Article -

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Everything You Need To Know

What is single-port laparoscopic nephroureterectomy?

Single-port laparoscopic nephroureterectomy is a minimally invasive surgical procedure used to treat upper urinary tract cancer. Unlike traditional laparoscopic nephroureterectomy, which uses multiple small incisions, this technique utilizes a single incision, often in the navel. The key advantage is reduced invasiveness, leading to less tissue damage, less scarring, and potentially reduced postoperative pain. The T-LESS approach takes this a step further by performing the distal ureter and bladder cuff dissection through a single port directly into the bladder.

How does the T-LESS technique work in single-port laparoscopic nephroureterectomy?

The T-LESS (transvesical single-port) approach involves excising the distal ureter and bladder cuff through a single entry point within the bladder. This means the surgeon accesses the area where the ureter connects to the bladder through one port. This method is designed to be highly precise and minimizes trauma to the surrounding tissues, leading to faster recovery times for patients. This differs from traditional methods that might involve several incisions to manage the same area.

What are the benefits of using the T-LESS approach over traditional methods?

The T-LESS approach offers several benefits. It reduces invasiveness with a smaller incision, leading to less tissue damage and scarring. It enhances precision by allowing direct access for meticulous dissection and removal of cancerous tissue. Patients typically experience faster recovery times and shorter hospital stays. Also, the single incision improves cosmesis, resulting in a less noticeable scar. Overall, the T-LESS approach aims to provide a less traumatic and more effective treatment option.

What were the key findings of the study on T-LESS for single-port laparoscopic nephroureterectomy?

The study published in *Videosurgery Miniinv* examined the outcomes of using the T-LESS approach for en-bloc dissection of the distal ureter and bladder cuff during LNU. The study found that all procedures were successfully completed without significant blood loss or complications. The average operative time for the T-LESS stage was approximately an hour, and patients experienced relatively short postoperative hospital stays. These initial results suggest that T-LESS is a safe and effective method.

How might single-port laparoscopic nephroureterectomy and the T-LESS approach change the future of kidney cancer surgery?

Single-port laparoscopic nephroureterectomy, particularly with the T-LESS approach, has the potential to become a standard practice in treating upper urinary tract cancer. As techniques evolve and more data become available, it's likely that this minimally invasive approach will become increasingly prevalent. This method offers patients a less traumatic and more effective treatment option. The shift towards single-port techniques, combined with the precision of the T-LESS approach, represents a significant step towards improving patient outcomes and the overall experience of kidney cancer surgery.