What Is a Laparoscopic Nephroureterectomy?

How is a laparoscopic nephroureterectomy done?

Laparoscopic nephroureterectomy may involve the following steps:

• The surgery is performed under general anesthesia. 
• 3-5 incisions (5-12 mm) are made in the abdomen, through which a telescope, camera, and functional equipment are inserted.
• A small incision (about 2-3 inches) in the lower abdomen is made to aid in the removal of the lower ureter and a piece of the bladder.
• The specimen is placed in a sterile retrieval bag for analysis.
• The surgery usually takes 3-4 hours, and the pathology report is usually done in 5-7 working days.
• In some cases, this procedure can be performed with the help of a da Vinci robot, thanks to advances in technology and surgical expertise. 

Following the procedure, the pathologist will thoroughly examine the specimen. A benign tumor will be the ultimate diagnosis in 15% of individuals. There is no certainty that the procedure will be curative, and additional treatment may be required.

What are possible risks of laparoscopic nephroureterectomy?

Although the procedure has proven to be safe and effective, there are risks to any surgical procedure. These risks include:

• Bleeding
• Infection
• Hernia
• Postoperative pain
• Blood clots
• Hernia at the incision sites
• Damage to nearby nerves, blood vessels, soft tissues, or organs
• Cancer returning or tumor seeding (spillage of tumor cells that can grow into new tumors)
• Problems with the remaining kidney, which could lead to kidney failure
• Heart attack or stroke
• Death

The benefit of these new approaches (laparoscopic and robotic) is that they require smaller incisions (keyhole surgery), resulting in less blood loss, less postoperative pain, and much faster overall recovery. The majority of people are discharged after 24-48 hours of surgery and are back at work within 10-14 days.

What is transitional cell carcinoma?

Transitional cell carcinoma (TCC) affects the transitional cells in the urinary system and accounts for the vast majority of bladder cancers. This cancer has the potential to spread quickly, affect other organs, and in some cases become life-threatening.

TCC develops from the lining of the ureter (the tube that connects the bladder to the kidneys). Although TCC starts in the ureter, in advanced cases it spreads (metastasizes) to other parts of the body. Because the prostate is connected to the urinary system through ducts, it is the most commonly affected organ. Cancer cells can also migrate to the breast, colon, or lungs.

What causes transitional cell carcinoma?

Although the exact cause of transitional cell carcinoma (TCC) is unknown, factors that may increase the risk of developing the cancer include:

• Obesity
• Smoking
• Exposure to carcinogens
• Consumption of water with high arsenic levels
• Urinary infections
• Kidney and bladder stones
• Bladder catheters left in place for a long period of time

What are symptoms of transitional cell carcinoma?

Symptoms of transitional cell carcinoma (TCC) vary, and people with early-stage or low-grade TCC may have no symptoms at all. However, as the condition advances, the following symptoms may appear:

If you have concerns about your symptoms, talk to a doctor for proper evaluation.

What are treatment options for transitional cell carcinoma?

Treatment for transitional cell carcinoma (TCC) depends on several factors, such as the type of cancer, stage, and severity.

The most common treatment of TCC of the kidney is surgery. Depending on the stage and severity of the cancer, you may receive chemotherapy or (in rare cases) radiotherapy after surgery. If your cancer has progressed, you may be treated with chemotherapy or a combination of chemotherapy and radiotherapy.

Treatment options for TCC include:

• Surgery: The majority of people undergo radical nephroureterectomy, which removes the kidney, ureter, and a portion of their bladder and has the best chance of curing the disease. Some of the neighboring lymph nodes and surrounding tissue may be removed. If the tumor is small and located in the ureter, your surgeon may be able to remove a portion of it in a procedure called segmental ureterectomy. 
• Chemotherapy: If the cancer has spread to the surrounding tissue or lymph nodes, chemotherapy may be administered after the surgery. This lowers the likelihood of the cancer returning. Chemotherapy may also be recommended if the cancer is advanced and you are not eligible for surgery.
• Regional chemotherapy: Regional chemotherapy involves inserting the tube through your urethra and into your ureter. Alternatively, a nephrostomy tube may be used.
• Radiotherapy: Radiotherapy is rarely used to treat TCC of the kidney or ureter. However, this treatment may be recommended if you are unable to have surgery or if your cancer has spread to adjacent tissue.

New therapies for TCC continue to be investigated by researchers.