RAJESH LAUNGANI MD FACS
Home | About Us | Contact Us | Treatments | Robotic Prostate Surgery | FAQ's about Robotic Prostate Surgery | Robotic Kidney Surgery | Robotic Kidney Surgery II | Robotic Surgery for Bladder Cancer | For Patients
Robotic Kidney Surgery II

ROBOTIC PARTIAL NEPHRECTOMY

Partial nephrectomy removes the cancer while preserving the normal and unaffected portion of the kidney, thus preventing the loss of the entire kidney. The kidney tumor must be cut out precisely to ensure complete removal.  The area of the kidney that has been cut out must be closed with complex surgical techniques. Robotic assistance can allow the surgeon to perform these complex steps with greater ease and precision. Robotic partial nephrectomy can provide a minimally invasive, kidney sparing option for kidney tumors, avoiding the potential need for a total nephrectomy or open surgery An advantage of removing only the tumor from the kidney instead of removing the entire kidney is that the patient will have more normal kidney remaining, with a lower chance of long term kidney failure, dialysis, or other medical problems.  Today, most patients with kidney cancer have tumors that can be treated with a kidney-sparing approach. Dr. Laungani routinely performs this specialized and complicated operation, using advanced robotic surgical technology.  Most patients with kidney tumors are eligible for a minimally-invasive and kidney-sparing approach, allowing the kidney cancer to be removed while saving the kidney. 

Partial nephrectomy does not increase the chance of recurrence (the cancer coming back) when performed by experienced surgeons on appropriately selected patients.  Performing a partial nephrectomy with conventional laparoscopic instruments can be challenging to achieve precise tumor excision and reconstruction of the kidney.   Robotic surgery allows the surgeon to perform these complex steps with greater precision and accuracy.  

How Robotic Partial Nephrectomy Works: 
1.The kidney is exposed and the blood vessels going to the kidney are identified.  The kidney tumor is  then identified.
2.Blood flow then is stopped to the kidney using special vascular clamps. This temporary occlusion of blood flow is necessary in most cases, to prevent bleeding as the tumor is being removed. 
3.The entire tumor is cut out of the kidney using the precise robotic instruments to maintain a margin of normal tissue around the tumor.
4.The kidney is reconstructed to prevent bleeding after removal of the tumor. A variety of methods are used to reconstruct the kidney. 
5. After the kidney is reconstructed, the blood flow to the kidney is restored by removing the vascular clamps which are on the blood vessels supplying the kidney.  The kidney is inspected to ensure there is no bleeding from where the kidney was cut. The tumor is removed from the body through one of the small incisions.

Advantages
The major advantage of removing only the tumor from the kidney instead of removing the entire kidney is that the patient will have more normal kidney remaining in order to maximize kidney function and lower the risk of long term kidney failure. Large studies have shown that worsening kidney function increases the risk of other medical problems such as heart attack, stroke, and death.  Also, if something happens to the other kidney, the patient will still have one in reserve. Laparoscopic partial nephrectomy can be a challenging procedure.  By utilizing robotic assistance for partial nephrectomy, some patients may be able to avoid removal of the entire kidney or a large and more painful incision  to perform a partial nephrectomy via an open surgery.

Complications
A partial nephrectomy is more challenging than a radical nephrectomy and it takes longer to perform. There is a slightly higher chance of complications, such as bleeding or a urine leak.  In large laparoscopic series, this risk ranges from 1-4%.  With the greater precision and visualization offered by robotic assistance, there is potential for improved reconstruction of the kidney to minimize these complications.  

Our Results
Piedmont Hospital has excellent results with robotic partial nephrectomy and is one of the few centers in the world that routinely offer robotic surgery for patients with kidney cancer.                             

ROBOTIC radical NEPHRECtOMY

Some patients with larger tumors may not eligible for kidney sparing surgery, but these patients can still receive  minimally-invasive approach to remove the kidney. The surgery itself, known as a Robotic Radical Nephrectomy, is performed with tiny keyhole incisions. Through these incisions, robotic surgical instruments and a camera are inserted to perform the surgery. After inflating the abdomen with gas, the colon is moved away from the kidney.

The kidney normally has a covering of fat around it. This fat is left on the kidney so the cancer is not exposed. After the kidney is dissected, the blood vessels going to the kidney are located. After the artery and vein to the kidney are identified, they are clipped or ligated. This cuts off the blood flow to the kidney and allows the kidney to be removed. 

Once the blood vessels are divided, the rest of the kidney is removed from its attachments. In some cases, the adrenal gland is removed with the kidney. After the kidney is totally freed up, it is placed into a bag to prevent any spillage of tumor and it is removed from the body through a small incision. Then the incisions are closed and the patient is taken to the recovery room.