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Total Knee Replacement Surgery (TKR) icon

Procedure Name

Laparoscopic Nephroureterectomy
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Surgery Type

Closed (Laparoscopy)
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Hospital Stay

2-3 days
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Duration of Surgery

2 to 3 hours
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Type of Anesthesia

General Anesthesia
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Full Recovery

3 to 4 weeks

Overview

Nephroureterectomy, also known as ureteronephrectomy, is a surgical procedure that involves the removal of your kidney, renal pelvis (the center part of the kidney which collects urine), ureter (a long tube that drains urine from the kidney into the bladder), and the bladder cuff (a small piece of tissue where the ureter connects to the bladder). It is most often performed to treat a special type of cancer or tumor affecting the upper urinary tract, known as urothelial cancer or transitional cell carcinoma (TCC).

What Is Laparoscopic Nephroureterectomy?

Kidneys are complex organs, the most important part of the urinary tract system. These bean-shaped organs are present on either side of the spine, filter waste and excess fluids, produce urine and regulate blood pressure within your body. Any abnormality or pathology can impose its function, causing permanent damage. 

Laparoscopic nephroureterectomy is an advanced, minimally invasive (involves small incisions with minimal bleeding and trauma) technique that uses a special scope known as a "Laparoscope." It is a flexible fiber-optic instrument with a light source and a tiny camera at the tip. When inserted into the abdominal cavity, it captures interior images and projects them on a large screen that guides the surgeon in carrying out the procedure.

When Is A Laparoscopic Nephroureterectomy Recommended?

Urothelial cancer begins in the urothelial cells that line the renal pelvis, bladder, ureters, and urethra (a tube through which the urine flows out of the body). Almost 90% of bladder cancers are urothelial cancers which present with the following symptoms:

  • Hematuria (blood in the urine)
  • Pain and burning sensation while urinating
  • A prominent abdominal mass in the kidney area
  • Frequent urination
  • Frequent nocturnal (nighttime) urination
  • Repeated kidney infection with fever, chills, and body aches.

If left untreated, urothelial cancer can impair normal renal (kidney) function and permanently damage your kidney. Laparoscopic nephroureterectomy is a standard surgical procedure recommended to remove the tumor cells, thereby restoring normal kidney function. It is most often the preferred choice of surgical procedure for aggressive TCC.

Other general indications of laparoscopic nephroureterectomy:

  • When the patient does not want to undergo invasive open surgery.
  • Patients with a busy schedule prefer a lesser hospital stay.
  • Patients who can afford a laparoscopic procedure (since the laparoscopic technique is expensive compared to an open approach).

How To Prepare For A Laparoscopic Nephroureterectomy?

It is important you identify the early signs of TCC (weight loss, bloody urine, burning sensation while urinating) and consult a urologist (a doctor who specializes in the diseases of the urinary tract).

  • Your urologist will take a detailed history of your symptoms and discuss further action.
  • The following tests will be recommended to confirm the diagnosis:
    • RFT (Renal Function Test)- It is a type of blood test to evaluate your blood urea nitrogen (BUN), and creatinine levels.
    • Routine urine analysis- To check for any bacterial urinary tract infections.
    • Urine cytology- This test will examine your urine microscopically to check for abnormal cells since the cancer cells related to kidney tumors are most often shed in the urine.
    • Intravenous pyelogram (IVP)- A special dye will be injected into your veins, and the flow will be checked through X-ray images to check for any blockage. 
    • Ureteroscopy- This test uses a special scope that is a thin tube with a light source and camera to view the interior of the ureter and renal pelvis and takes tissue samples.
    • CT (Computed Tomography), and MRI (Magnetic Resonance Imaging) scans- These provide a detailed picture of the inside of the ureter and renal pelvis.
    • X-ray and ECG (electrocardiogram)- To check for any abnormalities of the lungs and heart to evaluate your overall health.
  • You must inform your surgeon about:
    • Any medical condition like asthma, diabetes (increased blood sugar levels), thyroid, heart or lung diseases, or any blood disorders.
    • Any allergy to medications or anesthesia 
    • History of previous surgeries
    • Medications are being taken that include blood thinners, anti-inflammatory drugs, and other herbal supplements.
  • Your surgeon will prep you for the surgery for optimal results and a smooth recovery post-surgery. You will be advised to:
    • Avoid the medications like blood thinners for at least 2 weeks before the procedure to minimize the risk of bleeding.
    • Avoid smoking and alcohol for 2 weeks pre-procedure to prevent delayed wound healing.
    • Be on a liquid diet 24 hours before the procedure and fast after midnight.
    • Arrange someone to stay with you in the hospital for 2 to 3 days.

How Is Laparoscopic Nephroureterectomy Performed?

On the day of the surgery, the nurse will check your vitals (blood pressure, pulse, heart rate, urine output), and you will be asked to sign a consent form (to allow the surgeon to perform the procedure on you).

  • You will be wheeled to the operating theater, and your anesthesiologist (a doctor who administers anesthesia and specializes in pain management) will administer general anesthesia (GA).
  • The surgical site (abdomen) where the incisions (cuts) are made will be disinfected with an antiseptic solution to remove surface contaminants.
  • Your surgeon will make multiple (3 to 4) keyhole-sized incisions (cuts) measuring approximately 0.5 to 1 cm through either of the two approaches:
    • Transperitoneal- Performed through the peritoneum (the membrane that lines the abdominal cavity)
    • Retroperitoneal- Space between the abdominal or peritoneal cavity
  • A laparoscope is inserted through one of the incisions and the images of the interior are captured and projected on the screen.
  • Carbon-dioxide gas is injected into the surgical site to inflate the abdominal cavity for better visualization.
  • The surgeon, with the help of these images, will gently insert tiny surgical instruments through other incisions.
  • The nephroureterectomy will involve:
    • Renal pelvis excision (removal) and the associated kidney after detaching it from the surrounding structures and blood vessels.
    • Ureterectomy - The entire length of the affected ureter.
    • Bladder cuff excision - The bladder cuff of the associated ureter is also removed to prevent any future tumor recurrence
    • Lymphadenectomy- Lymph nodes (small beans shaped organs that are part of your body’s immune system) are removed since TCC is an aggressive tumor that spreads to the surrounding lymph nodes.
  • Once the excision is complete, small drainage tubes will be inserted to facilitate fluid and blood drainage.
  • The incisions will be closed through small stitches with the tubes in place.
  • The procedure will take around 2 to 3 hours, depending on the severity of the tumor.

What To Expect After A Laparoscopic Nephroureterectomy?

Once the surgery is complete, you will be shifted to a recovery room or PACU (post-anesthesia care unit) to monitor your vitals closely. 

  • Once the vitals are stable, you will be shifted to your room, where you are expected to stay for 2 to 3 days.
  • You may feel groggy (dizzy) until the effect of anesthesia wears off. You may expect mild pain and discomfort on the day of the surgery, which will resolve gradually.
  • Your surgeon will continue your IV painkillers and antibiotics for 2 to 3 days until you are discharged.
  • A urinary catheter will be placed for 1 to 2 days post-procedure to drain the urine. The urine collected in the bag will help evaluate the urine output during the course of hospitalization.
  • You will be on a liquid diet for 24 hours following the nephroureterectomy procedure. 
  • Semi-solid foods will begin once you no longer feel nauseated due to the effect of anesthesia. 
  • The day after the surgery, you will be made to walk as walking helps to limit the risk of blood clots in your legs. 
  • Once you are healthy enough to move around independently and your vitals are stable, you will be discharged from the hospital.

Recovery at Home 

  • Proper rest, a healthy diet, and hydration are important for healing.
  • Mild pain at the incision site is normal and will resolve gradually through the painkillers prescribed.
  • You will be allowed to shower at home with a waterproof surgical dressing placed at the incision site. However, make sure to pat dry the wound site. 
  • You must refrain from saunas, tub baths, and swimming for at least 2 weeks after the surgery.
  • Regular walks and low-impact exercises (like yoga) are important to prevent leg blood clots. 
  • You should avoid driving for 1 to 2 weeks after the surgery as it may impair wound healing.
  • You must not lift heavy weights or perform strenuous exercises for 3 to 4 weeks after surgery since it may lead to wound separation and possible risk of hernias.
  • Drink 6 to 8 glasses of water to keep yourself hydrated.
  • You will be scheduled for an appointment with your nutritionist, who will help plan out your diet. 
    • You will probably be put on a low-salt and low-protein diet.
    • You must reduce spicy, oily, and junk foods to avoid bloating and constipation.
  • You should follow up with your surgeon after 7 to 10 days. Your surgeon will examine you and check the progress of your recovery.
  • You should be able to resume your job 4 weeks after surgery. 
  • Recovery may take around 3 to 4 weeks.

What Are The Benefits And Risks Of Laparoscopic Nephroureterectomy?

Laparoscopic nephroureterectomy is a safe and effective procedure that facilitates the removal of renal cancer cells to improve renal function. 

Benefits 

  • The procedure not only removes the cancer cells but also removes the associated organs. This limits further metastasis and lowers the risk of tumor recurrence. 
  • It improves your survival rate by preventing recurrence.
  • Relieves symptoms associated with TCC.

Benefits of the laparoscopic method:

  • Small incisions with minimal scarring.
  • Minimized bleeding during the procedure.
  • Lesser hospital stay.
  • Quick recovery and return to normal activities.
  • Minimal postoperative complications. 

Risks 

Laparoscopic nephroureterectomy is a popular alternative to an open nephroureterectomy; however, a few associated risks are listed below:

  • Damage to the surrounding structures since the visibility may be compromised as compared to an open surgical approach.
  • Numbness and tingling sensation at the surgical site due to damage to the nearby nerves.
  • Allergic reactions due to anesthesia- That cause hives, rash, itching, dizziness, confusion, and breathing difficulties.
  • Seroma- A condition characterized by fluid-up at the surgical site.
  • Blood clots- Due to prolonged immobility, blood clots can develop in the veins of the leg and these may eventually dislodge in the bloodstream and travel to internal organs like the lungs and heart and cause respiratory or cardiac arrest.
  • Hematoma- Abnormal mass of clotted blood can develop.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!

The power of Medfin in patient’s words

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“ Got to know about them from my friend. They got an appointment for only 299. Once the doctor confirmed that I needed the surgery they got me a fixed cost which included ALL the costs. No extra amounts were charged. Thank you Medfin”

Suresh Menon Hyderabad 8 days ago
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“ After my consultation with the doctor, MEDFIN representative got me a fixed package cost that included my mothers initial tests, surgery cost. They also gave me stockings free for Rs. 3000 post the surgery. They kept up their promise they made”

Radhika Iyer Mumbai 8 days ago
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