Editing Segemental ureterectomy (section)

== Proximal or mid-ureter ==

* '''Achieving a clear margin and still being able to mobilize enough well-vascularized ureter to perform a tension-free anastomosis is paramount to the success of this procedure and the major limiting challenge'''
* '''Technique'''
** Position: full or modified flank position
** Incision: flank incision from the tip of the 12th rib provides access to the proximal ureter or mid-ureter.
** Summary of Steps:
*** With use of an extraperitoneal approach, the ureter is identified, mobilized, and secured with vessel loops.
*** The tumor is palpated, and the ureter is ligated 1 to 2 cm above and below the suspected tumor margin (Fig. 58-22). This location can be also verified by preoperative cross-sectional imaging.
*** The diseased ureter is excised and clear margins ascertained by frozen pathology.
*** After regional lymphadenectomy is performed, both ends of the ureter are spatulated and anastomosed with an interrupted 4-0 Vicryl suture. If a large segment of ureter is excised, mobilization and descensus of kidney may be performed to provide additional length to the proximal ureter. A ureteral stent is placed before completion of the anastomosis.