Robot-assisted radical nephrectomy is a keyhole operation in which the entire kidney is removed for kidney cancer. It is usually performed when it is not possible just to remove the tumour itself.
Removing the kidney is the mainstay of treating kidney cancer, with chemotherapy and radiation not having much effect in this condition. Traditionally the operation used to be performed with a large incision in the flank, stretching from the edge of the rib cage and across the flank towards the belly button. (See figure 1). With the advent of keyhole surgery in the late 90's and early 2000's, many urologists began performing this surgery with laparoscopic techniques, allowing the kidney to be disconnected internally and then removed through a much smaller skin incision, often only 10cm, which allows a much quicker recovery period. The use of the Da Vinci® Surgical system has made this somewhat challenging operation more straightforward, especially for cases with complicating factors, such as obesity, prior kidney surgery or kidney infections, and complex anatomy. The use of the robotic platform allows for greater dexterity and safety in cases with these complicating issues.
Dr Pokorny will discuss with you whether your past medical history means a robotic approach is favoured, or whether the procedure can be done with traditional laparoscopic instruments.
The procedure usually lasts 90 minutes to 2 hours, and is performed with 4 to 5 small incisions and one larger incision at the end (+/-10cm) to remove the kidney. (See Figure 2) Patients can eat and drink normally the next day and usually go home at about 3 to 4 days after the operation, when feeling comfortable and able to perform all their own cares. We normally recommend no heavy lifting or strenuous exercise for 6 weeks after surgery, and to avoid driving for 1-2 weeks.
Patients are usually seen for a checkup at 6 weeks after surgery, and then every 3 months for the first year. Patients are then seen every 6 to 12 months, with an annual scan of the remaining kidney, a chest X-ray and blood tests to ensure no sign of any cancer recurrence.