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A laparoscopic nephroureterectomy is an operation in which the kidney and ureter are removed using keyhole, or laparoscopic, surgery techniques. The ureter is the tube through which urine drains from the kidney into the bladder. A laparoscopic nephroureterectomy may be carried out to treat a cancer of the kidney. Laparoscopic surgery uses smaller incisions than traditional surgical techniques, as slender surgical tools are inserted through small openings, together with a viewing instrument which enables the surgeon to see the procedure on a screen. The kidney and ureter are removed and extracted through one of the incisions, and recovery is quicker than with traditional open surgery.
Cancer sometimes arises in the cells which line the ureters and the collecting spaces inside the kidneys. Symptoms may include blood appearing in the urine and cramping pains experienced in the side of the abdomen. The purpose of a laparoscopic nephroureterectomy is to remove the kidney and its ureter before the cancer spreads. Sometimes, a small part of the bladder is also removed.
Preparing for a laparoscopic nephroureterectomy involves undergoing medical checks to ensure fitness for the procedure. On the day of the nephroureterectomy, it is necessary to stop eating and drinking at least six hours before the operation. This type of kidney surgery is carried out under a general anesthetic, so the patient remains asleep.
During the laparoscopic nephroureterectomy a number of cuts, of small size, are made in the skin of the abdomen. Tubes are inserted through the cuts and the laparoscope, an instrument containing a camera, is passed into the abdomen through the tubes, allowing images of the procedure to be collected. The images are then viewed on a screen, so the surgeon can monitor the process. Specially modified surgical instruments are inserted through other tubes and used to cut the kidney and ureter away from surrounding tissues. Finally, the ureter and kidney are pulled out of the abdomen after widening one of the incisions a little.
After a laparoscopic nephroureterectomy, patients are encouraged to eat, drink and move around as soon as they feel able. Becoming mobile helps to reduce the risk of some of the possible complications of a laparoscopic nephroureterectomy. These include blood clots developing in the legs, and chest infections. Most patients do not suffer any side effects.
The wound is normally drained through a tube, which remains in position for up to 48 hours after the operation. Another tube, known as a catheter, is used to drain the bladder while it heals, which can take up to around ten days. Although it is usually possible to return home after a few days, recovery from surgery could take a number of weeks.
My mother had a tumour in her ureter which the surgeon advised needed a total nephroureterectomy and a partial bladder removal. I would have thought this was standard procedure My mum's tumour was, however, aggressive and found on a biopsy having had haematuria for weeks unresolved.
CT scan with contrast shows TTC of the right renal pelvis. The surgeon went in with a small tool and tried for three hours under a general to yank the cancer out. He only got 60 percent out. He said he will go back in and get the rest out in two weeks and grade it. He said he may have to go in later and take out the kidney and ureter.
Isn't this doctor putting the cart before the horse? Should chemo be offered to shrink this 1.5cm mass and then re-think this and not put the patient through three surgeries? Thanks. -- A worried wife of a 65 year old man.
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