What is en bloc resection of multiple urologic organs？

The en bloc resection of multiple urologic organs refers to the “bilateral nephrectomy with bilateral ureterectomy and radical cystectomy.” As the name suggests, it’s a procedure where both sides of the kidneys, both ureters, and the bladder are removed, considered the most extensive surgery in urology.

What kind of patients need to undergo such extensive surgery?

In Taiwan, there is a high prevalence of chronic kidney disease and patients undergoing dialysis, who are at a higher risk of developing multiple urinary tract epithelial tumors compared to the general population. Prolonged dialysis in patients not only results in the loss of urinary organ function but also carries the risk of potential malignancy. Therefore, patients who need to undergo this surgery generally fall into two categories:

• Patients concurrently suffering from bladder tumors and tumors in both kidneys or ureters, which cannot be treated by organ-preserving methods.
• While long-term dialysis patients are diagnosed with bladder, kidney, or ureter tumors, imaging studies (such as CT scans or MRI) might reveal other suspicious lesions that could also be tumors. After discussions between the physician and the patient, the decision is made to surgically remove all urinary organs to prevent malignancy in the future.

Perioperative risks?

Given the extensiveness of this surgery, traditionally, it requires opening the entire abdomen to complete the surgery. While dialysis patients often experience weakened physical condition, compromised immunity, and poor cardiovascular function due to long-term dialysis, making them more susceptible to postoperative complications such as infections, unstable blood circulation, intestinal obstruction, electrolyte imbalances, and pulmonary edema.

The role of Da Vinci robotic surgery system?

With the assistance of the Da Vinci robotic surgery system, this surgery can be performed through several small incisions and one four to five centimeters incision (for specimen removal). This method allows for more delicate tissue dissection, reducing intraoperative bleeding, and expediting the patient’s postoperative recovery.

Conclusion: En bloc resection of multiple urologic organs is a major surgery that requires detailed discussion with the physician beforehand. The Da Vinci robotic surgery system can expedite the patient’s postoperative recovery.