Laparoscopic nephroureterectomy

Laparoscopic nephroureterectomy is used to surgically treat tumors of the renal collecting system and ureter, as well as some congenital abnormalities, such as a duplex collecting system of the kidney.

How is it performed?

In order to perform laparoscopic nephroureterectomy, we require 4-5 trocars inserted through the left or the right side of the abdomen. After detaching the colon and opening the parietal peritoneum above the affected kidney, we reveal the lower half of the kidney and the fatty capsule, and detach the blood vessels as far from the kidney as possible. We continue to detach the entire kidney and the fatty tissue without disconnecting the ureter. We proceed to free up the ureter all the way to the urinary bladder. In cases of tumors, we also resect a part of the urine bladder wall at the point of entry of the ureter.

The removed kidney and ureter are inserted in an endoscopic bag. Then, a drainage tube is inserted in order to monitor and control possible post-operative bleeding, as well as urine secretion. The endoscopic bag is removed through an extended incision made in the best spot of the muscle wall to avoid cutting muscle. The remaining trocars are removed, and the incisions are stitched up.

What are the possible complications?

In the hands of an experienced surgical team, complications in laparoscopic nephroureterectomies are rare. The most common possible complication is bleeding that might require a blood transfusion. There are also general risks of laparoscopic surgery, such as the damage of stomach organs. However, these risks are minimal and occur in less than 1% of all patients. Approximately less than 2% of laparoscopic nephroureterectomy surgeries require a conversion to the open surgical approach.