When you have been diagnosed with a higher grade or solid TCC tumor in the kidney, minimally invasive laparoscopy treatment is available for you at the Minimally Invasive Urology Institute. Laparoscopic treatment is less painful, requires a shorter stay in the hospital and a faster recovery than traditional kidney surgery.
Total removal of the kidney and the ureter, which can be done via laparoscopic nephroureterectomy, is recommended in the following cases:
- For confirmed multifocal disease (medium- to high-grade)
- For confirmed high-grade disease or solid tumors
- For confirmed locally invasive disease
- For large tumor burden, where RIRS can not remove all tumor
If your tumor requires that your kidney be completely removed, laparoscopy may be an option for you. The kidney, the fat tissue around it and, if needed, the adrenal gland can be removed this way. Also, the entire ureter and a cuff of the bladder (where the ureter runs into the bladder) are removed. The approach is the same as for a tumor of the kidney. The kidney and ureter are reached through three little incisions that are made into the abdomen to allow small surgical instruments to go to the kidney. The kidney and its surrounding fat are completely freed up inside the abdomen.
The entire kidney and ureter with the surrounding fat tissue are removed through a small cut in the midline in the skin. No muscle is cut. Additionally, two small openings in the abdomen allow entry into the bladder for removal of the lowermost portion of the ureter. As a result, there is less pain, a shorter hospital stay and faster recovery.
This approach usually requires a one- to two-night stay in the hospital.
- For patients with low- to medium-grade, multi-focal TCC
Using a rigid or flexible ureteroscope, a retrograde intrarenal surgery is done to examine the tumors. Ureteroscopy is a minimally invasive endoscopic procedure that allows the surgeon to do surgery inside the ureter without making an incision. The ureteroscope enters through the natural opening of the body into the bladder and the ureter. Ureteroscopy is used for stones in the ureter, narrowing of the ureter (strictures), tumors and removal of foreign materials. The URS is an outpatient procedure done under local, intravenous or general anesthesia. These tumors can be sampled for diagnostic and therapeutic purposes and removed or destroyed with the laser.
When your kidney has multiple papillary TCC tumors or the tumor is of medium-grade (or both), you may be a candidate for chemo/immunotherapy in addition to the surgery to preserve your kidney.
When the surgery is over, a suprapubic catheter tube is put into the bladder and up into the involved kidney. This tube is exposed through the belly and provides a port through which chemotherapy will be delivered later in the doctor's office.
Two weeks after the tumor surgery and the placement the tube, the patient will return to the doctor's office for topical chemo/immunotherapy. One of two medications is used: BCG (Bacillus Calmette-Guerrin) or MMC (Mitomycin-C). The solution enters through the tube while the patient is lying on an examination table. The medication will flow from an IV bag into the tube directly into the kidney. It takes about 30 minutes to an hour. This treatment will be given weekly for about six weeks. The patient will then be evaluated in the doctor's office using cystoscopy and endoscopy (with topical lidocaine anesthetic). A cytology exam will also be done. If the results of these two evaluations are negative, the follow-up regimen will be done again in six months, then at 12 months, then once a year after that. At each visit, a cystoscopy and endoscopy with cytology will be done in the doctor's office. A yearly visit with a cystoscopy, endoscopy and cytology exam would be the indefinite follow-up plan. A positive cytology would require a re-evaluation of the treatment plan, with the possibility of more surgery or additional MMC or BCG therapy.
You may be a candidate for a type of surgery in which only the tumor on the kidney is removed and the rest of the kidney is preserved. Use of this procedure depends on the size of the tumor and where it is, among other factors. To remove part of the kidney, two minimally invasive laparoscopy procedures are available for you.
Partial nephrectomy removes that part of the kidney with the tumor, leaving the rest of the kidney intact. Depending the tumor's location and size, the laparoscopic approach may be a valuable, minimally invasive treatment option for you. Laparoscopic partial nephrectomy is available at the Minimally Invasive Urology Institute.
In laparoscopy, three small incisions are made into the abdomen to allow small surgical instruments to enter the abdomen. The part of the kidney to be removed is cut and taken out through one of the small incisions. No muscle is cut so recovery is faster and less painful than with traditional options. An overnight hospital stay is needed.
For some patients with small tumors (less than three centimeters) on the outer border of the kidney, cryoablation may be a valuable, minimally invasive treatment option. Laparoscopy is used to reach the tumor on the surface of the kidney. Under laparoscopy and ultrasound control, the tumor is frozen so that the tumor cells eventually die. An overnight stay in the hospital is needed.
