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Robotic partial nephrectomy

Robotic partial nephrectomy is a procedure to remove a cancerous tumour from the kidney with a small margin of normal tissue surrounding this. This leaves as much normal functional kidney in place as possible. Where possible nowadays, urologists attempt to remove only the tumour instead of the whole kidney for kidney cancer. The procedure uses keyhole surgery techniques through the Da Vinci robotic surgical platform. The surgery is technically challenging but made significantly easier through the enhancements provided by the robotic instruments in 3D, in comparison to standard laparoscopic 2D surgery. The surgery is performed through 4 to 5 small incisions in the abdomen measuring 1-2cm, and the specimen is removed by enlarging one of these incisions slightly. The surgery typically takes 90 min to 3 hours, depending on the tumour size and complexity of the resection required. Patients are typically in hospital for 2-4 days afterwards. Recovery is fairly rapid given the small size of the incisions. The surgeon uses intraoperative ultrasound to demarcate the edges of the tumour within the kidney during the excision.

A catheter and surgical drain is placed after surgery, and these are usually removed on the first postoperative day. Patients are able to eat and drink on the first day and move around normally. When comfortable and caring for themselves, patients can be discharged home. Patients should avoid heavy lifting and strenuous activity for 6 weeks, and can drive after 1-2 weeks.

The risks of surgery include bleeding from the kidney surface during removal of the tumour, bleeding after the surgery in the first 48 hours, damage to the bowel, liver or spleen, and sometimes having to convert the operation to removal of the entire kidney. The chance of major complications is generally low, in the range of 1-5%.  Other less significant issues include ileus (slow bowel activity) for 24-48hrs, nausea and pain as in any surgery, and complications from the anaesthetic.

Usually no other treatment is needed after partial nephrectomy, providing the entire tumour is removed completely. Patients undergo regular follow up for several years afterwards, with serial scans performed of the operated kidney to ensure no local problems, and to exclude any evidence of cancer spread despite full clearance of the tumour.