Robotic-assisted partial nephrectomy

After prostate cancer and bladder tumours, kidney cancer is the third most common malignant urological tumour. In Slovakia, approximately 600 new cases of kidney cancer are diagnosed every year. The incidence of kidney cancer is rising worldwide, especially in developed countries.

Thanks to the availability of modern imaging methods such as ultrasound, CT or MRI, kidney tumours are increasingly diagnosed at an early stage of the disease, that is, before any clinical symptoms appear. If kidney cancer already causes clinical symptoms /flank pain, blood in the urine, a palpable tumour/, it is a sign of advanced disease. Fortunately, today the vast majority of patients come to our department in the first stage of the disease. At this stage the disease is fully curable, and the treatment is surgery. If the kidney tumour is suitably located, it is not necessary to remove the whole kidney to cure the patient. It is enough to remove just the tumour with a small margin of healthy parenchyma. The patient therefore keeps practically the whole kidney, which is a huge advantage. In patients with a functionally or anatomically solitary kidney, radical removal of the whole kidney would lead to haemodialysis, with all its negative consequences for quality of life.

Robotic-assisted partial nephrectomy is performed with the da Vinci robotic system. At F. D. Roosevelt University Hospital we work with the da Vinci X system from Intuitive Surgical.

The operation is performed under general anaesthesia and takes approximately 1.5–2 hours. It is performed through access ports into the abdominal cavity (trocars), through which special instruments are inserted that the surgeon uses to carry out the whole procedure. The operation requires two experienced surgeons, one at the console and the other at the patient's side. The assistant helps with dissection and haemostasis, changes instruments, introduces sutures and clips and applies the vascular clamp.

The patient is placed in the lumbotomy (flank) position. After the ports are inserted, docking follows – connecting the ports to the robot's arms. The extent of kidney mobilisation depends on the location of the tumour. In most cases extensive mobilisation of the kidney is not needed. This is followed by stopping blood flow through the kidney /so-called warm ischaemia/ by applying a vascular clamp, resection of the tumour and suturing of the tumour bed. After suturing, we check haemostasis and place a drain next to the kidney. The tumour removed from the kidney is taken out of the body in a special plastic bag through a small skin incision. The end result is 5 small scars on the abdominal wall.

Recording of a real operation:

Perhaps the greatest advantage of robotic partial resection over open surgery is the incomparably smaller incision. This of course means significantly less pain and faster recovery. While after open surgery the patient has a scar 20–25 cm long, robotic surgery leaves only a few tiny mini-incisions.

Safety and good results have been repeatedly demonstrated by several studies. Where it is technically possible to preserve the kidney, robotic-assisted kidney resection is a safe minimally invasive method, and at our department it is already the gold standard.

Further benefits:

The most advanced surgical technique
A precise procedure with a short warm ischaemia time
Low blood loss
Fewer post-operative complications
Excellent oncological results
A short hospital stay
Cosmetic result

Before the procedure you need to undergo a thorough examination and a consultation with a urologist, who will assess your diagnosis, health, expectations and treatment options. The urologist will explain the course, risks and benefits of robotic-assisted partial nephrectomy and answer your questions. You will also be told how to prepare for the procedure, what to expect afterwards and how to look after yourself during recovery.

If you are interested in robotic-assisted partial nephrectomy, talk to your urologist and find out whether this treatment option for kidney cancer is suitable for you. Robotic-assisted partial nephrectomy is a modern and oncologically safe method that can improve your quality of life and prognosis.

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For more information about robotic-assisted partial nephrectomy, see the following sources:

Gallery

Kidney tumour removed during partial nephrectomy

Illustration of robotic resection of a kidney tumour

Illustration of the partial kidney resection procedure

Illustration of a kidney tumour and blood vessels

Information for patients booked for robotic surgery at Roosevelt Hospital

Please bring to your hospital admission:

Pre-operative internal medicine examination and blood clotting tests
Pre-operative anaesthesia assessment (if you are admitted for surgery on a working day, we will do it at Roosevelt Hospital on the day of admission. If you are admitted on a Sunday, you must come to our admissions clinic on the Friday before your hospital stay so that we can send you for the anaesthesia check-up at our hospital)
Stop taking blood thinners, or switch them to low-molecular-weight heparin, 10 days before the operation
If you are registered for surgery elsewhere, you must cancel that registration, because your health insurance company will not allow us to book you for surgery with us.
The medicines you are currently taking
The signed patient informed consent form (you will receive it on admission, or you can print it here)
The results of imaging – CT, MRI – must be brought to the operation and also uploaded to the hospital PACS via the hospital's CT archive (in the connecting corridor between the outpatient building and the inpatient wing).

What to expect after robotic-assisted partial nephrectomy?

After the procedure you will be taken to the ward or, exceptionally and only if necessary, to the intensive care unit, where you will be monitored and treated. You will have a catheter to drain urine and a drain to remove blood. You will also receive antibiotics to prevent infection and an intravenous infusion with painkillers to relieve pain.

Post-operative care

After the operation you will stay in hospital for approximately another 2 to 3 days, depending on your health and how you recover. Under standard circumstances we remove the drain and the urinary catheter on the first day after the operation and check the wounds. If everything is fine, the patient is discharged home the following day.

After discharge from hospital you will need to follow the urologist's instructions, which include:

Taking blood thinners such as Fraxiparine for 28 days as prescribed
Checking the incision sites and caring for them as instructed
Drinking plenty of fluids to stay well hydrated

After this operation there are two situations that require you to come back to the hospital emergency department. The first is a temperature above 38 °C lasting more than 24 hours; the second is abdominal cramps and inability to pass wind. In that case an imaging examination is needed to find the possible cause of the problems.

Approximately one month after the operation you will come for a post-operative check-up, where we will go through the histology results (after every operation we send the specimen for histological examination) and agree on the next steps.