What is a laparoscopic radical nephroureterectomy?
Laparoscopic radical nephroureterectomy is a minimally invasive surgical procedure to remove the renal pelvis, kidney and entire ureter, along with the bladder cuff, in an attempt to provide the greatest likelihood of survival for patients with transitional cell cancer.
What are the advantages of laparoscopic radical nephroureterectomy over an open procedure?
- Reduced hospital stay and faster healing
- Less postoperative pain and less need for pain medication
- Shorter recovery time
- Quicker return to normal activity or work
- Smaller incisions and less scarring
How long has the Cleveland Clinic been performing laparoscopic radical nephroureterectomies?
The Cleveland Clinic has the most experience of any health care center in the world with this technique and, since 1997, has been employing this procedure routinely with excellent results.
The Cleveland Clinic was one of the first centers to perform renal transplantation since the mid 1960’s. Currently, more than 95% of the radical nephroureterectomies performed are done laparoscopically.
Why would someone need a laparoscopic radical nephroureterectomy?
Knowing your options is the first step in kidney cancer treatment.
The kidney, ureter, and bladder are lined by tissue called transitional epithelium. Laparoscopic radical nephroureterectomy is used to treat patients who have transitional cell cancer of the upper urinary tract or transitional epithelium.
What happens before a laparoscopic radical nephroureterectomy?
For 24 hours prior to surgery, you'll be asked to have a clear liquid diet. Your surgeon will ask you to not eat anything starting at midnight the night before your surgery. If you have medications you are instructed to take, take them with a small sip of water.
Your doctor will advise you to discontinue certain medications and supplements a week before surgery. Aspirin, Motrin, Ibuprofen, Advil, Vitamin E, and others can increase the risk of bleeding during surgery. Ask your doctor before discontinuing any medications. Each patient is different.
What happens during a laparoscopic radical nephroureterectomy?
First, you'll be given general anesthesia to put you to sleep for this procedure. Unlike a conventional nephroureterectomy, laparoscopic surgery requires only several small incisions. Through these incisions, a surgeon uses a powerful endoscope – a tiny camera (that gives the surgeon a magnified view with greater clarity than in a traditional open surgery) – and specialized surgical instruments to remove the diseased organs.
The surgeon will isolate the kidneys and other organs to be removed from your body's blood flow. They kidney and ureter are then separated from the structures which hold it in place. They are then extracted from a small incision.
This process may sound complicated, but your physician at Cleveland Clinic will be able to answer any questions you have regarding laparoscopic radical nephroureterectomy.
How long does laparoscopic nephroureterectomy take?
Surgery takes approximately 3-4 hours, and the hospital stay is usually one to two days. Full recovery usually takes two to three weeks.
What happens after a laparoscopic radical nephroureterectomy?
After this procedure, you'll be taken to a recovery room and monitored for any potential complications. Once you wake up, you will be treated for pain and continue to be monitored. If you experience nausea (potentially related to anesthesia), you will be given medication to help treat it.
For one to two days after surgery, you'll be given a liquid diet to help give your body time to recover. After that time, your physicians will help transition you back to real food. This process is differently paced for every patient.
The day after surgery, your nurses will encourage you to get out of bed and walk around. This helps the recovery process by limiting the risk of blood clots in your legs, prevents pneumonia, and encourages the healing process.
After you are discharged, you should avoid driving for two weeks after the procedure. It is very important for you to take it easy for six weeks (or as instructed by your doctor) and not do any heavy lifting (over 20 pounds). Walking as exercise is possible and highly encouraged after surgery. Most patients are able to return to work after 4 weeks. However, these are general guidelines and all patients are different. Ask your doctor if you have any questions.