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Minimally Invasive Surgery / Laparoscopic Procedures
Removal of Kidney and Ureter (Laparoscopic Nephroureterectomy)
- Indications - The kidney, ureter and bladder is lined by tissue called transitional epithelium. When cancer occurs within this lining it is referred to as transitional cell carcinoma. Symptoms may include pain, bleeding or bladder irritation. The diagnosis is confirmed by performing ureteroscopy and obtaining tissue biopsy. If cancer is diagnosed tests are performed to determine if the disease has spread. In patients with disease confined to the urinary tract, treatment includes removing both the kidney and ureter.
In the past this operation required a two large incision, one in the flank and a second incision in the lower abdomen. Using laparoscopy this same procedure may be performed using 3 to 4 small keyhole incisions.
- Procedure - The patient must undergo general anesthesia for this procedure. First, the ureter where it enters the bladder is freed using a specially designed cystoscope. Next, four to five small cylindrical tubes called trocars are placed into the abdominal cavity. The trocars allow entry of a video-telescope, called a laparoscope, to view the entire abdominal cavity and kidney. The video-telescope gives the surgeon a magnified view of the operating field and allows identification of vessels and structures with more clarity than is possible in open surgery. Accessory small trocars allow the introduction of fine instruments necessary to perform surgery. With all the trocars and instruments are in place the vessels which bring blood to and from the kidney are clipped . The kidney and ureter are now freed from all their surrounding structures. The ureter is dissected all the way down to the bladder. The kidney and ureter are then removed as one by extending one of the trocar incisions 2 to 3 inches.
- Results - Several investigators including ourselves have compared laparoscopic nephroureterectomies to standard open nephroureterectomies in terms of operative time, estimated blood loss, pain medication requirement, length of hospital stay, time to return to normal activity and complications. We have concluded that though the operative time appears longer the amount of pain medication required, time in hospital and time to return to work is significantly shorter. In addition there was no increase in complications and blood loss was similar in both groups. After the operation the patient is required to have a tube draining the bladder (Foley catheter) for 7-10 days to insure proper healing of the bladder. This precaution is also required when performing the older open procedure.
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