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.

The procedure

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
  • Less pain
  • Shorter hospital stay
  • Quicker recovery
  • Better cosmetic result

Results

Cancer control

Robotic-assisted laparoscopic nephroureterectomy controls cancer equally as well as the traditional open procedure.

Blood loss

Typical blood loss is 100-200cc. Blood transfusions are extremely rare.

What to expect after surgery

Hospital stay

The typical hospital stay is 2 days.

Diet

A clear liquid diet is started the day after surgery and a regular diet on the second day.

Postoperative pain

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.

Urinary catheter

A urinary catheter is left in place for 1 week following the surgery and then removed.

Recovery

Most patients are able to return to full activity within 3-4 weeks compared with 8-12 weeks for open radical nephrectomy.

Follow-up

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.