{"id":72913,"date":"2025-07-28T09:02:40","date_gmt":"2025-07-28T15:02:40","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=72913"},"modified":"2025-07-28T09:58:05","modified_gmt":"2025-07-28T15:58:05","slug":"top-bladder-cancer-surgeon-saves-lives-with-robotic-surgery","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/top-bladder-cancer-surgeon-saves-lives-with-robotic-surgery\/","title":{"rendered":"She leads the field of bladder cancer robotic surgery in North America, helping patients make the right call"},"content":{"rendered":"
<\/div>
\"Dr.
Dr. Janet Kukreja performs about 150 cystectomies each year at UCHealth University of Colorado Hospital using the Da Vinci Xi robot. She leads the field of robotic bladder removal surgery in North America. Photo by Sonya Doctorian, UCHealth.<\/figcaption><\/figure>\n

By Todd Neff and Katie Kerwin McCrimmon<\/p>\n

When it comes to life-saving bladder cancer surgeries, Dr. Janet Kukreja<\/a> is the top surgeon in the U.S.<\/p>\n

Kukreja is North America\u2019s most prolific \u201ccystectomist.\u201d This means that she performs radical cystectomies \u2014 the removal of a cancerous bladder and neighboring tissues, followed by the sewing together of alternatives \u2014 all via a surgical robot.<\/p>\n

Kukreja does about 150 of these robotic surgeries each year at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>. Kukreja is also an associate professor of urology surgery<\/a> at the University of Colorado School of Medicine.<\/p>\n

As the leading surgeon in her field, Kukreja cares for patients from multiple states in the Rocky Mountain region and across the U.S. She\u2019s also a mentor and teacher for newer doctors who are learning how to save the lives of bladder cancer patients.<\/p>\n

Intuitive Surgical, maker of the Da Vinci Surgical System<\/a>, which Kukreja uses for her robotic surgeries, sends doctors from around the country to Colorado to learn how to do cystectomies. Newer surgeons watch and listen as Kukreja works.<\/p>\n

She credits her expertise in part to her youth and her willingness to embrace new technology.<\/p>\n

Kukreja knew she wanted to be a surgeon.<\/p>\n

\u201cWhen I was a medical student, I decided to explore urology because my grandfather had prostate cancer. I knew I wanted to do cancer care, but I wasn\u2019t sure exactly what I wanted to do,\u201d she said.<\/p>\n

After attending medical school at the University of Missouri, Kansas City, Kukreja took the advice of a research mentor who encouraged her to become the world\u2019s expert in robotic bladder cancer surgery.<\/p>\n

\u201cYou should make this your life\u2019s work,\u201d Kukreja\u2019s mentor told her.<\/p>\n

And so she did.<\/p>\n

Kukreja learned robotic surgery in parallel with open surgery during her residency at the University of Rochester, which she wrapped up in 2016. In 2018, she completed a fellowship at the University of Texas at Houston\/MD Anderon Cancer Center Program. It was clear that robotic bladder surgery was just as effective in removing cancerous tissue and had the advantages of smaller incisions, less blood loss and faster recovery.<\/p>\n

More senior surgeons, Kukreja said, \u201chad to make this transition where they went from open to robotics, and I was just kind of born a robotic surgeon. It\u2019s like when you learn two languages, English and Spanish, from birth versus learning Spanish as a second language. So, I\u2019ve always been bilingual, in that sense.\u201d<\/p>\n

\"Kukreja
Kukreja at the Da Vinci controls during the removal of a cancerous bladder. She and the team built a neobladder from a portion of the patient’s intestine during the four-to-five-hour surgery.\u00a0 Photo by Sonya Doctorian, UCHealth.<\/figcaption><\/figure>\n

When a cancerous bladder tumor requires surgery<\/strong><\/h2>\n

For patients, receiving a bladder cancer diagnosis can be utterly devastating. That\u2019s when Kukreja steps in to offer guidance and options.<\/p>\n

Ryan Kenney, 52, of Eagle, received life-saving care from Kukreja.<\/p>\n

Kenney, who joined the Vail Police Department in 2017 and became chief of police in 2023, is also an avid mountain biker. In the summer of 2021, he noticed pain when urinating. A local doctor suggested switching out his mountain bike saddle. It didn\u2019t help. A cystoscopy determined why: Kenney had a bladder tumor, and it looked cancerous. The urologist recommended he see Kukreja.<\/p>\n

Kenney asked, \u201cAm I going to survive this?\u201d<\/p>\n

The urologist said she couldn\u2019t really answer that yet.<\/p>\n

Bladder cancer can be very dangerous if it\u2019s not treated early, Kukreja said.<\/p>\n

\u201cIt can be lethal,\u201d she said. \u201cIf it\u2019s not managed appropriately, people die from it.\u201d<\/p>\n

If left untreated, the cancer can spread quickly and kill people within a year or two.<\/p>\n

\u201cOnce it metastasizes, the survival rates are grim,\u201d Kukreja said. \u201cIt\u2019s only 10% at five years. That\u2019s on par with pancreatic cancer. It\u2019s very bad.\u201d<\/p>\n

Bladder cancer is the tenth leading cause of cancer death in the U.S.<\/a>, according to the American Cancer Society.<\/p>\n

The causes of bladder cancer are also unclear.<\/p>\n

\u201cAbout 50% of cases are associated with smoking, but we don\u2019t know what causes the other 50%,\u201d Kukreja said.<\/p>\n

Like many patients, Kenney never smoked, so he\u2019ll never know what caused his cancer.<\/p>\n

But many other people find themselves in Kenney\u2019s shoes.<\/p>\n

Bladder cancer is the fourth most common cancer in men, behind prostate, lung and colon cancer, according to the National Cancer Institute<\/a>.<\/p>\n

Among women, bladder cancer is less common, but it can still be dangerous. Bladder cancer is among the 11th<\/sup> most common type of cancer that women get. The most common types of cancer in women are breast, lung, colon, uterine, melanoma, lymphoma, pancreatic, thyroid, kidney, leukemia and bladder cancer.<\/p>\n

Bladder cancer: ‘Am I going to survive this?’<\/strong><\/h2>\n
\"Vail
Vail Police Chief Ryan Kenney. Photo courtesy of Ryan Kenney.<\/figcaption><\/figure>\n

Uncertainty hung over Kenney, his wife Vicki, and their daughters, Summer, Rayna, and Reef, for a month until his October 2021 appointment with Kukreja at the UCHealth Tony Grampsas Urologic Cancer Care Clinic on the Anschutz Medical Campus<\/a>.<\/p>\n

Kukreja introduced herself and got right to the point.<\/p>\n

\u201cWhat do you need to know right now?\u201d she asked.<\/p>\n

Kenney asked what he had asked the Eagle County urologist a month earlier.<\/p>\n

\u201cOf course, you\u2019re going to survive this,\u201d Kukreja said. \u201cIn a couple of months, you\u2019ll be back to 100%, and you won\u2019t even remember my name.\u201d<\/p>\n

Kukreja would be half right.<\/p>\n

A biopsy showed the tumor to be an aggressive cancer. The options included chemotherapy with uncertain chances of success and bladder removal. Kenney underwent his robotic cystectomy on Dec. 29, 2021. Less than four months later, he was mountain biking in Fruita.<\/p>\n

Of course, it wasn\u2019t that simple. First, radical cystectomies consistently involve the removal of the bladder, nearby lymph nodes, and, sometimes, neighboring organs. But then they can go in one of two very different directions, both having to do with the plumbing after bladder removal surgery.<\/p>\n

The first involves an ileal conduit (a.k.a. urostomy), in which a surgeon takes a section of the small intestine called the ileum and uses it as the end of a pipeline that exits the body near the belly button. Urine collects in a bag outside the body.<\/p>\n

The second has Kukreja stitching together a replacement bladder, called a neobladder, typically out of a longer section of the ileum. Kukreja is among the few robotic surgery experts who routinely construct neobladders via the quarter-inch-thick stainless-steel arms of a robot halfway across the operating room.<\/p>\n

And while living with an external bag versus a replacement bladder seems a simple choice (in fact, 90% of bladder cancer patients who undergo bladder removal go with the ileal conduit rather than the neobladder), Kukreja devotes a lot of effort and attention to making sure patients understand the pros and cons of both. Her academic research centers on it, in fact.<\/p>\n

Putting the patient\u2019s needs first when discussing bladder removal surgery<\/strong><\/h2>\n

Kukreja has led a project to develop a web-based app to help patients answer urinary diversion questions based on their personal circumstances and preferences. It explains both procedures and their risks and benefits. There are vignettes of patient stories and sliders to establish their values to help patients decide how to proceed.<\/p>\n

The goal, she says, is to put the ultimate direction of bladder removal surgery in the hands of the patient. Too often, she says, \u201cthey\u2019re very heavily swayed by the paternalism of the doctor. They\u2019re like, \u2018Well, doc, what do you think I should do?\u2019 And a lot of doctors say, \u2018Well, I think you should do an ileal conduit because it\u2019s the easiest.\u2019 But it\u2019s not necessarily the easiest. It\u2019s kind of what fits your life best.\u201d<\/p>\n

\"Kenney
Kenney was back on the mountain bike trails less than four months after his bladder removal surgery. Photo courtesy of Ryan Kenney.<\/figcaption><\/figure>\n

With the ileal conduit, you have to deal with the bag. But you sleep through the night, for example, something bladder cancer patients often haven\u2019t done for a very long time. A neobladder leaks for a couple of months, particularly at night, before the body gets used to a new sensation of having to go (rather than familiar bladder pressure, it feels like gas pressure). Even then, patients end up having to get up at least once a night.<\/p>\n

Kukreja explained this and much more to Kenney.<\/p>\n

\u201cShe\u2019s so good at laying out your options and explaining the positives and negatives. She just made it such an informed choice,\u201d he said.<\/p>\n

He went with the neobladder.<\/p>\n

For two months, tubes and healing connections prevented strenuous physical activity as Vicki and their daughters cared for him. Kenney regained much of his cardiovascular fitness by the time he was biking Fruita. Having lost some 50 pounds, most of it muscle, during his time on the shelf, his gym-related strength took longer. But as Kukreja had promised him in that first meeting, he was back to feeling like himself within months.<\/p>\n

She was wrong, though, about him forgetting her name.<\/p>\n

\u201cDr. Kukreja saved my life,\u201d Kenney said. \u201cAnd she\u2019s amazing.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

By Todd Neff and Katie Kerwin McCrimmon When it comes to life-saving bladder cancer surgeries, Dr. Janet Kukreja is the top surgeon in the U.S. Kukreja is North America\u2019s most prolific \u201ccystectomist.\u201d This means that she performs radical cystectomies \u2014 the removal of a cancerous bladder and neighboring tissues, followed by the sewing together of […]<\/p>\n","protected":false},"author":23,"featured_media":72915,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,49,457,9179],"class_list":["post-72913","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-cancer-treatment","tag-mens-health","tag-urologic-cancer-treatment-2"],"acf":[],"yoast_head":"\nTop bladder cancer surgeon saves lives with robotic surgery - 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