Robotic-Assisted Nephroureterectomy
A robotic-assisted nephroureterectomy is a minimally invasive surgery to remove the kidney and ureter due to conditions such as cancer or severe disease. Using robotic technology, the surgeon performs the procedure with small incisions, offering greater precision, less pain, and a faster recovery compared to traditional open surgery.
Indications for Surgery
This procedure is typically recommended for:
- Upper urinary tract urothelial carcinoma (UTUC) – A type of cancer affecting the kidney’s lining or ureter.
- Severe ureteral stricture – A narrowing of the ureter causing obstruction.
- Non-functioning kidney – A kidney that is no longer working due to chronic disease or damage.
How is the Surgery Performed?
- The procedure is done under general anaesthesia and takes 2-4 hours. You will have a urinary catheter placed at the start of the operation.
- Several small incisions are made in the abdomen, and the abdomen is insufflated with gas (carbon dioxide).
- A robotic system is used to control tiny instruments for precise removal of the kidney and ureter. The surgeon carefully separates the affected kidney from the surrounding tissues and blood vessels. The robotic system allows for precise cutting while minimising bleeding.
- The entire ureter is removed as well as a small cuff of bladder, and the bladder is then closed with sutured.
- A larger incision about 6-10cm in length in the lower abdomen is made to remove the entire kidney and ureter in a specimen bag.
- The incisions are closed, and a drain is placed.
Usual Postoperative Course
- Hospital Stay: Most patients stay 2-4 days in the hospital.
- Drain Tube: The drain is usually removed after a couple of days.
- Pain Management: Mild to moderate pain is common and managed with medications. Shoulder tip pain and incision pain is common.
- Activity: Light activity is encouraged but avoid heavy lifting for 4–6 weeks.
- Diet: A normal diet can be resumed gradually.
- Urinary Catheter: A catheter will be removed in 1 week after a cystogram is performed to ensure no leak from the bladder.
- Full Recovery: Most patients recover at 6 weeks.
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