Robotic Nephroureterectomy

Robotic Surgery for Transitional Cell Cancer (TCC) of the Upper Urinary Tract

Robotic nephroureterectomy is a surgical treatment in which the surgeon removes the patient's kidney and ureter (the tube that carries urine from the kidney to the bladder). It is performed primarily to treat transitional cell carcinoma—a cancerous growth in the lining of the urinary tract, that can occur in the kidney, ureter or bladder—in patients were the tumor is confined to the upper ureter and/or kidney with no evidence of metastasis. In the past, nephroureterectomy was traditionally done as an open procedure, requiring a large incision extending from the patient's flank to his or her pelvis. With robot-assisted surgery, this same procedure may be performed in a minimally invasive fashion using a series of small incisions, thereby reducing trauma on the patient's body and leading to faster healing and recovery.

How Robotic Nephroureterectomy is Performed

After the patient is anesthetized, five ports are put in place using quarter-inch incisions. The robot's camera and three instrument arms are inserted through four of the ports. The surgeon then uses the instruments to free the kidney and ureter are from all their surrounding tissues, after which the kidney artery and vein are clipped and divided using special instrumentation specifically designed for this purpose. The ureter is freed down to the bladder, where it is transected (cut crossways) along with a small cuff of bladder. The kidney, ureter and bladder cuff are then placed into a bag and brought out through one of the port sites. In order to remove the kidney and ureter intact the port site incision is extended to measure 6 to 7 cm.

Advantages of Robotic Nephroureterectomy

Less post-operative pain. The small incisions used for this procedure are considerably less painful than the large abdominal incision used for open nephroureterectomies. This is confirmed by data comparing minimally-invasive nephroureterectomy to open surgery, which indicates that patients undergoing the robotic procedure use significantly less pain medication.
Shorter hospital stay and recovery. Most patients leave the hospital within 2 to 3 days after robotic nephroureterectomy, compared to 4 to 7 days for open surgery, and are able to resume normal activities within 2 to 3 weeks, versus 4 to 6 weeks for open procedures.
Enhanced surgical capabilities as a result of improved visualization and precision.At the NYU Langone Robotic Surgery Center, it's been our experience that by utilizing robotic technology, we can dissect the distal ureter (the part of the ureter closest to the bladder) and then suture the bladder permanently shut at the time of the procedure more easily than with the laparoscopic approach, in a fashion similar to the open procedure. In addition, lymphadenectomy (removal of the regional lymph nodes) is routinely performed in conjunction with this procedure, both for cancer control and as a staging procedure to gauge the extent of the cancer. The improved visualization and manipulation of instrumentation offered by the da Vinci Si surgical system may make this phase of the operation safer as well, compared to standard laparoscopic techniques.

Robotic Nephroureterectomy at NYULMC

At NYU Langone Medical Center, we have great expertise in performing laparoscopic nephroureterectomy and have published widely on our extensive experience with this procedure. Nonetheless, we believe robotic nephroureterectomy provides better visualization and control of the distal ureteral dissection and excision of bladder cuff and also improves our ability to perform lymphadenectomy compared to laparoscopic surgery. As a result, it is now becoming our technique of choice.

Research by NYULMC Physicians on Nephroureterectomy

Meet Our Surgeons

Video Library

To watch a video of this procedure being performed by one of NYU Langone Medical
Center's robotic surgeons, click on the link below.