Why would someone need a robotic partial nephrectomy? Read about robotic partial nephrectomy!

(Prof(Dr) Anup Kumar : MS, MCh(Urology- AIIMS), DNB(Urology), MNAMS)

Surgery is generally the first line treatment for localized kidney cancer (cancer that has not spread). Partial nephrectomy is the surgical removal of a portion of a kidney (normally used to treat cancer), while preserving as much healthy kidney tissue as possible. Traditionally this procedure has been performed as an open surgery through a larger 8-12 inch incision in the flank, sometimes requiring removal of one of the patient’s ribs or through minimally invasive approaches such as laparoscopic or robotic surgery. Robotic partial nephrectomy is a minimally invasive alternative, performed with specialized finely articulating instruments inserted through tiny incisions ,which are used to precisely remove the tumor alone and preserve the remaining kidney under hand control of surgeon(the surgeon does not need to place his/her hand inside the abdomen) These minimally invasive approaches give equal cancer control to that of open surgery and make for an easier recovery after surgery with low overall complication rates and allows for patients to return to their daily lives with a minimum of inconvenience, despite having undergone major surgery.

Why would someone need a robotic partial nephrectomy?

Patients may be candidates for robotic partial nephrectomy if they have a small kidney tumor or when removing the entire kidney could result in kidney failure and the need for dialysis. Because of recent medical breakthroughs, robotic partial nephrectomy is the preferred method of surgical intervention for patients with smaller kidney tumors <4 cm in size. However, tumors between 4 and 7 centimeters can be treated with robotic partial nephrectomy if they are located in certain areas and based on surgeon’s expertise.

What happens before a robotic partial nephrectomy?

You will be assessed for fitness by anaesthetist before surgery. If you take blood thinners such as warfarin/aspirin you will be instructed to stop taking those 5 to 7 days before surgery. Anti-inflammatory medications and certain vitamin supplements can cause increased bleeding which has to be disclosed to your surgeon and anesthesiologist. It is very important that in preparation for your surgery to stop smoking. Tobacco harms the body’s natural ability the heal itself which is very important after robotic kidney surgery. You will be asked to not eat or drink anything after midnight the night before your surgery. You will be instructed to take your blood pressure medicine the morning before surgery and you may do so with small sips of water.

 

What happens during a robotic partial nephrectomy?

You will be given general anesthesia so they can be unconscious/asleep for the procedure. You will lie on your side during surgery. A robotic partial nephrectomy is performed through 3-4 “keyhole” incisions, each ≤  1cm in the abdomen where the robotic surgical equipment and camera can be inserted. The abdominal cavity is then inflated with carbon dioxide gas to provide space for the manipulation of the surgical equipment and camera to access the cancerous tissues. The blood flow to the cancerous kidney could be temporarily stopped, allowing the kidney to be dissected under hand command/control of the surgeon and cancerous portion to be removed from the surrounding healthy tissue. Special tools like intraoperative ultrasound is used to confirm the site of the tumor and help guide the resection by accurate imaging of the tumor with an ultrasound probe. A special dye(firefly imaging) may be used to help differentiate tumor from normal kidney to ensure that as much normal kidney is saved as possible. The surgeon sews the remaining section of healthy kidney tissue back together. The tumor is placed inside a retrieval bag and removed through one of the incisions. Small drainage tube is placed inside the abdomen and incisions are closed. Tumor is sent to the pathologist to ensure the entire tumor was removed with no residual tumor left behind and to know the type of cancer.

What happens after a robotic partial nephrectomy?

After your surgery, you will be monitored closely and treated for post-procedure pain with pain medications and management techniques that are appropriate for you. You’ll be encouraged to walk around shortly after your surgery to encourage healing, blood flow, and to restore normal functioning. Walking after surgery also helps prevent pneumonia, DVT (clotting in blood vessels) and other complications. The post op day 1, you’ll be given a liquid diet. As you heal and recover from surgery, you’ll be reintroduced to a solid normal diet. Urinary catheter is removed on day 1 and drain is usually removed on day 2. You will be discharged on day 2 or 3 and adviced to follow up at regular intervals

 

ADVANTAGES:

  • 3D Vision of surgical field (depth perception)
  • Improved visualisation with magnification
  • Precise dissection with finely articulating instrument tips
  • Lesser pain
  • Shorter hospital stay
  • Quicker recovery
  • Better cosmetic result
  • Lesser bleeding with lower transfusion rates
  • Fewer infections
  • Fewer wound hernias
  • Overall low complication rates
  • Cancer control equal/superior to open surgery
  • Overall improved quality of life