What is Robotic Partial Nephrectomy?

Partial nephrectomy is a surgery preferred for patients with smaller kidney tumors less than 4 cm in size, where in only the tumor and a surrounding rim of the kidney is removed. However, tumors between 4 and 7 centimeters can also be treated with partial nephrectomy, if they are located in certain areas and technically feasible. It is considered as a treatment option for kidney cancer that has not spread beyond the kidney.

 

Robot Assisted Laparascopy surgery is one of the most advanced method of performing partial nephrectomy as it incorporates the principles of open surgery and applies them to a robotic-assisted, minimally invasive approach. Thus, the precision and dexterity of advanced instrumentation facilitates outcomes comparable to open surgery but with the advantages of a minimally invasive

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

Advantages Robotic Partial Nephrectomy

  • Improved visualization of surgical field
  • Less pain
  • Shorter hospital stay
  • Quicker recovery
  • Better cosmetic resultLpartialNxincisions
  • Lower transfusion rates
  • Fewer infections
  • Fewer wound hernias

What happens before a robotic partial nephrectomy?

You will meet to your surgeon to discuss your pre-admission process, and to ensure you are fit to go ahead with the procedure.
Please inform the team if you are:

  • Diabetic
  • Have a cough, cold, or any kind of infection.

You must also inform us prior to attending if you are taking any of the following medications:

  • Aspirin, warfarin, clopidogrel (these are likely to need to be stopped some days before the surgery).
  • Antibiotics
  • Bring Your Medical report

Anti-inflammatory medications and certain vitamin supplements can cause increased bleeding so disclose all of your medications and supplements to your surgeon and anesthesiologist.

 

It is very important that in preparation for your surgery that you stop smoking. Tobacco harms the body’s natural ability the heal itself which is very important after robotic kidney surgery.

 

Your surgeon will ask you to not eat or drink anything after midnight the night before your surgery. This is to prevent negative effects of the potential nausea that some patients experience due to anesthesia. Your surgeon may instruct you 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?

A patient will be given general anesthesia so they can be unconscious for the procedure.

 

A robotic partial nephrectomy is performed by making small incisions 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.

 

Under the command of the robotic surgeon, the blood flow to the cancerous kidney is stopped, allowing the kidney to be dissected and the cancerous portion to then be to then be detached from the surrounding tissue. The tumor is removed from the body and the surgeon sews the remaining section of kidney back together.

What happens after a robotic partial nephrectomy?

After your Robotic partial nephrectomy, you will be monitored closely by medical experts and treated for post-procedure pain. As stated before, laparoscopic nephrectomies are far less traumatic than open surgery. However, this does not mean it is pain-free. As you recover, you’ll be treated with pain medication 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 and other complications.

 

Immediately after surgery, you’ll be given a liquid diet. As you heal and recover from surgery, you’ll be reintroduced to a solid normal diet.

 

Normal functioning of the body can be maintained by a single healhty kidney. However, it is possible that your doctor will recommend a healthy diet for you to eat when you return home, physical activity, and regular checkups to help preserve kidney function.

Recovery after robotic partial nephrectomy?

Most patients are able to return to full activity within 4-6 weeks compared with 8-12 weeks for open partial nephrectomy.

Frequently Asked Questions (FAQ) Robotic partial nephrectomy?

What patients are not good candidates for robotic partial nephrectomy?

Patients with very large tumors or tumors invading surrounding structures (e.g. vena cava, liver, or bowel) may be best served by an open approach due to the extent and need for adjacent organ resection. Medical conditions such as severe lung and heart disease may not be able to tolerate a laparoscopic or robotic approach.

What is the difference between a laparoscopic and robotic approach?

Both are laparoscopic approaches and the choice of approach is a matter of surgeon preference. Operative times, blood loss, and hospital stays are similar between a pure laparoscopic and robotic technique. These procedures are performed by inflating the abdomen with carbon dioxide gas and placing a laparoscopic lens affixed to a high definition camera into the abdomen to view the internal organs. Conventional laparoscopic surgery involves hand-held instruments, while robotic surgery involves the use of a sophisticated robotic device (called the da Vinci S Surgical Robotic System) with wristed instrumentation to allow the surgeon to dissect within the abdomen while controlling these instruments externally from a surgeon console.

What happens if complications arise and conversion to open surgery is required?

Although extremely rare, conversion to open surgery may be required if difficulty with dissection is encountered during the laparoscopic approach. Our surgeons are trained in open surgical approaches as well as laparoscopy and therefore are well equipped to complete the surgery in an open fashion if needed.

What is the overall success rate of robotic partial nephrectomy?

Success rate in complete removal of the kidney tumor is similar to open surgical approaches. Prognosis of cancer-free survival is based upon the grade, stage and particular type of your cancer and will be discussed with you by your surgeon following surgery during review of the pathology report.

Will I need further treatment such as radiation or chemotherapy following surgery?

For patients with small, incidentally detected tumors on CT or MRI, prognosis remains excellent as most are cured with surgery alone. Rarely, patients are found to have large, invasive cancers that may require adjuvant treatment with medical therapies such as interleukin-2, interferon-alpha, or tyrosine kinase inhibitors. These would be administrated under advisement of a medical oncologist. Currently there is no utility for radiation or chemotherapy.

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