Robotic Partial Nephrectomy

A patient diagnosed with a tumor in the kidney may be a candidate for robotic partial nephrectomy. This operation involves removing the tumor, but sparing the rest of the healthy kidney. It is particularly indicated in patients that have only one kidney, have tumors in both kidneys, or have a poorly functioning non-tumorous contralateral kidney. Additionally, the patient’s individual tumor characteristics (size, location) will be evaluated through imaging studies to ascertain if partial nephrectomy is the indicated operation. As a general rule, partial nephrectomy is offered to patients with small tumors.

Robotic partial nephrectomy offers significant benefits to the patient as compared to other forms of surgery. Most importantly, when performed in the proper patients, it offers the same rate of cure as radical (total) nephrectomy, while conserving healthy kidney tissue. The minimally invasive nature of this operation leads to less pain post-surgery and to a faster time to full recovery. The small incisions made in the patient’s abdomen for the insertion of the robotic instruments heal quickly and result in much smaller scarring. A particular benefit of robotic partial nephrectomy is the assistance in this operation’s most difficult and time-sensitive step. In all forms of partial nephrectomy, in order to safely perform the operation, it is frequently necessary to block the flow of blood to the kidney. However, it is imperative to limit this time to the minimum necessary, as renal function deteriorates quickly especially after 30 minutes of obstructed blood flow. The articulated tips of the robotic instruments allow much faster suture of the tumor bed and more precise approximation of the remaining healthy tissues, efficiently controlling any bleeding or leakage of urine. This is a highly demanding step during laparoscopic surgery, but becomes much easier using the robotic surgical system.

Figure 1. Normal anatomy of kidney

Patients should expect to remain in the hospital for two days after surgery. During surgery, a urinary catheter and a drainage tube will be placed, and both will be removed in the first post-operative day. Also in the first day after surgery, the patient will be fed and mobilized. The minimal pain associated with robotic surgery leads to a smaller requirement of pain killers and allows the patient to take care of his or her basic needs.

Figure 2. Position of patient during robotic partial nephrectomy

Figure 3. Kidney with tumor undergoing partial nephrectomy, and suture of the remaining healthy tissues.