Kidney cancer and tumors
Laparoscopic surgery can be used for the following urologic procedures:
- Radical nephrectomy for cancer (Removal of the entire kidney)
- Radical nephroureterectomy for cancer (Removal of the entire kidney and the ureter which connects to the bladder)
- Partial nephrectomy for cancer (Removal of only part of the kidney)
- Radical prostatectomy for prostate cancer (Removal of the prostate for cancer)
- Live donor nephrectomy for transplantation
- Pyeloplasty for ureteropelvic junction obstruction (UPJ obstruction)
- Ureteral surgery for stones or strictures
- Pelvic lymph node dissection
- Adrenalectomy (Removal of the adrenal gland)
Laparoscopy is a minimally invasive alternative to standard open surgery in which a special camera called a laparoscope is used to produce an inside view of the abdominal cavity. Also called "keyhole" or "band-aid" surgery, laparoscopy is a minimally invasive procedure because it requires several small (1/2- to 1-inch) incisions rather than a single large one in the abdomen.
Laparoscopic surgeries have led to less invasive cancer surgeries with decreased pain and faster recovery times for patients. Because of the reduced size of the incisions, hospital stays are often shorter, with some patients even able to go home the next day.
During laparoscopic surgery, several long thin instruments, including a lighted camera called a laparoscope, are inserted into the patient's abdomen through small incisions. These instruments include scissors, graspers, and other instruments modeled after the typical instruments used in traditional open procedures.
There are certain limitations to laparoscopic surgery because the surgeon does not have direct contact with the patient's organs. First, the surgeon has limited range of motion due to the instruments being rigid and straight. Unlike the human hand and wrist, the laparoscopic tools can only move in certain directions, limiting the types of actions that can be performed. Second, the surgeon relies upon a two-dimensional screen displaying the patient's anatomy creating a loss of depth perception and impact on hand-eye coordination. A new alternative to laparoscopic surgery, which is increasing in popularity, is robot-assisted surgery.
Robotic surgery can help surgeons overcome many of the challenges presented by the open or laparoscopic surgery. Currently, the only FDA approved and widely used surgical robot is the da Vinci system, developed by Intuitive Surgical in Sunnyvale, CA. The da Vinci system is similar to the laparoscopic surgical platform in that long, thin instruments resembling traditional surgical instruments are inserted into the patient through small incisions. Therefore the benefits of robotic and laparoscopic surgery are very similar - less pain, shorter hospital stays, and faster healing times.
The da Vinci Surgical System is the only commercially available technology that can provide the surgeon with the range of motion, fine tissue manipulation capability and 3-D visualization characteristic of open surgery, while simultaneously allowing the surgeon to work through tiny incisions typical of laparoscopic surgery. The da Vinci system has three main parts: the console, where the surgeon sits to operate the robot; the patient side cart, which is positioned over the operating table and contains the arms that hold the instruments; and a third cart which provides a view of the surgery for the other doctors and nurses in the room. When the surgeon looks into the console, he sees a three-dimensional view of the patient’s internal organs and the surgical instruments, similar to what he would see in an open operation. Unlike an open operation, the camera can magnify the image, creating better visualization. The arms of the robot on are controlled by the surgeon using hand controls. Perhaps the largest advantage of the robot is in the design of the instruments. Unlike most laparoscopic instruments which can only move in certain directions, the da Vinci's instruments are wristed. The surgeon can manipulate the instruments in multiple directions, giving the surgeon freedom similar to that of an open platform.
There are limitations to robotic surgery. Unlike an open operation, the surgeon cannot feel the organs. When using the instruments to touch the organs, there is no tactile feedback, so surgeons must be extra vigilant about where each instrument is, in order to avoid damage to the organs. Finally, the da Vinci requires use of instruments that are manufactured only by Intuitive Surgical, Inc. If a procedure requires an instrument that is not currently available through the manufacturer, that part of the procedure must be completed by laparoscopically.
Robotic and Laparoscopic Surgery for Kidney Cancer
Surgical treatment options for stage I renal cancer (kidney tumors less than 7 cm without evidence of spread of cancer) including simple nephrectomy (removal of the kidney), radical nephrectomy (removal of kidney and surrounding tissues, glands and lymph nodes) and partial nephrectomy (removal of the tumor within the kidney and surrounding tissues, leaving the rest of the kidney intact). Most renal tumors that are less than or equal to 4 cm in size can be removed without removing the whole kidney. The benefits of partial nephrectomy for select tumors are equal success for cancer control and minimize loss normal functioning kidney therefore potentially decreasing one’s risk for renal insufficiency or renal failure. By leaving the healthy kidney behind, there is a decrease the risk of the patient going into renal ailure, which can possibly shorten a person's life.
Open kidney surgery often requires a large the incision which cuts through muscle and, often, requires removing part of a rib to get to the kidney. The incisions can be quite painful and often require a hospital stay of 3- 7 days.
Laparoscopic and robotic kidney surgery has really improved the recovery time and discomfort from surgery. In addition, with the advancement of robotic surgery, the surgeon is able to perform more complex surgery than he/she would have pure laparoscopicaly. Some of the major benefits experienced by surgeons using the da Vinci Surgical System over traditional laparoscopy have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. None of these benefits can be guaranteed, as surgery is necessarily both patient- and procedure-specific.
Most people are eligible for laparoscopic and robotic surgery. However, you may not qualify for the procedure if you have had multiple previous abdominal surgeries. As with all surgical procedures, there is a risk of complications. A physician will complete a preoperative evaluation to ensure that the procedure is appropriate for you. However, in a small percentage of cases, even approved laparoscopic and robotic procedures may be converted to open procedures. Reasons for conversion to an open procedure may include:
- A significant complication during surgery
- Blood loss
- If the operation is not proceeding as smoothly as the surgeon would like it to
Your surgeon will discuss potential risks in further detail with you prior to your procedure.