Understanding Robotic-assisted Nephroureterectomy
(Removal of Kidney and Ureter)
Nephroureterectomy, which is the removal of the kidney, entire ureter, and
a small piece of bladder where the ureter and bladder connect, may be
necessary when patients have been diagnosed with a mass or tumor within the
lining of the kidney and/or ureter. The kidney, ureter, and bladder are
lined with tissue called transitional epithelium. When cancer occurs within
this lining it is called transitional cell carcinoma or "TCC."
Traditional open surgery involves making an 8-20 inch incision in the flank
or abdomen, and in many cases removing a rib, as well as a second incision
in the lower abdomen to resect the entire ureter down to the bladder.
Postoperative pain and numbness near the wound site can interfere with
breathing and extend recovery. Robotic-assisted laparoscopic
nephroureterectomy, using small "keyhole" incisions, offers similar cure
rates but with decreased blood loss, shorter hospital stays and recovery,
less pain, and better cosmetic outcomes.
Under general anesthesia, trocars (cylindrical tubes) are placed into the
abdominal cavity through 3-5 small incisions (each ~ 1/2 inch long) to
allow insertion of the laparoscope. Next, carbon dioxide injected through
one of the incisions enlarges the cavity and separates the abdominal wall
from other organs. A laparoscopic camera provides a magnified view, making
it possible to identify vessels and structures easily.
Thin surgical instruments are then inserted. The vessels that carry blood
to and from the kidney are clipped. Once the kidney and ureter are freed
from surrounding structures, they are extracted and removed through an
incision (usually about 3 inches) in the lower abdomen. The wounds are then
closed with dissolvable sutures.
Advantages over open surgery
Improved visualization of surgical field
Less blood loss
Shorter hospital stay
Better cosmetic result
Robotic-assisted laparoscopic nephroureterectomy controls cancer equally as
well as the traditional open procedure.
Typical blood loss is 100-200cc. Blood transfusions are extremely rare.
What to expect after surgery
The typical hospital stay is 2 days.
A clear liquid diet is started the day after surgery and a regular diet on
the second day.
Pain is managed immediately with an intravenous patient controlled
analgesia pump, which is removed and replaced by pills the day after
surgery. Upon discharge, pain pills are given for several days, after which
over-the-counter acetaminophen or ibuprofen are usually all that is needed.
A urinary catheter is left in place for 1 week following the surgery and
Most patients are able to return to full activity within 3-4 weeks compared
with 8-12 weeks for open radical nephrectomy.
Patients will follow-up with their surgeon 1 month after the operation for
a routine visit. Appointments can easily be conducted over the phone for
patients living outside the Boston area, including international patients.