Laparoscopic Nephrouretrectomy

Laparoscopic Nephroureterectomy is a minimally invasive surgical procedure used to remove the kidney and the ureter, typically for conditions such as urothelial carcinoma (a type of cancer that affects the lining of the urinary tract). This approach offers advantages like smaller incisions, reduced pain, and faster recovery compared to open surgery.

Indications

1. Urothelial carcinoma of the upper urinary tract:
   • High-grade or invasive tumors in the renal pelvis or ureter.
2. Non-functional kidney due to chronic obstruction, infection, or other conditions affecting the ureter and kidney.
3. Recurrent ureteral or renal pelvic tumors unresponsive to conservative treatments.

Preoperative Preparation

1. Diagnostic Workup:

   • Imaging: CT urography, MRI, or ultrasound to evaluate the kidney, ureter, and tumor extent.
   • Cystoscopy: To assess for concurrent bladder tumors.
   • Renal function tests: To assess the unaffected kidney’s ability to compensate.

2. Patient Counseling:

   • Discussion of the procedure, risks, urinary implications, and postoperative expectations.

3. Anesthesia:

   • The surgery is performed under general anesthesia.

Procedure Overview

1. Positioning:

   • The patient is placed in a lateral decubitus position for kidney access.
   • For ureteral dissection, the position may be adjusted.

2. Port Placement:

   • Multiple small incisions are made to insert laparoscopic trocars.
   • A camera port provides visualization, and instruments are inserted through other ports.

3. Nephrectomy:

   • The kidney is carefully dissected from surrounding structures, including the adrenal gland, renal vessels, and ureter.

4. Ureterectomy:

   • The ureter is dissected along its length to ensure complete removal, preventing recurrence.
   • The distal ureter is detached from the bladder. This step may involve:
     • Open bladder cuff excision: Ensuring removal of the ureter’s intramural portion.
     • Transurethral resection: An alternative for distal ureter removal in select cases.

5. Specimen Retrieval:

   • The kidney and ureter are removed en bloc through an extended port or retrieval bag.

6. Closure:

   • The incisions are sutured or closed with surgical adhesives.
   • A drainage tube may be placed to monitor fluid output.