Robotic Urology

HOW WOULD I KNOW IF MY KIDNEY TUMOUR IS CANCEROUS?

Generally, most kidney tumours are cancers. Smaller tumours are more likely to be benign, however, benign kidney tumours should still be removed as they may grow over time.

SHOULD I HAVE A NEEDLE BIOPSY OF THE TUMOUR PRIOR TO TUMOUR REMOVAL SURGERY?

Traditionally, needle biopsies are rarely performed for kidney tumours due to risks of bleeding, tumour spread and false diagnosis. With improved technology, emerging evidence suggests that biopsy is safe and accurate. However, biopsy is indicated only if diagnosis is in doubt on radiology or patient is unfit for surgery. Once the tumour is removed from the body, a pathologist will formally evaluate to determine what kind of tumour it is. This gives the most accurate diagnosis.

ARE KIDNEY CYSTS CANCEROUS?

While some kidney cysts are cancerous, most are not. If a kidney cyst appears “complex” on a CT scan, MRI or ultrasound, then it may be cancerous and will need to be removed. Simple cysts usually do not need to be treated.

SHOULD I STILL HAVE MY KIDNEY REMOVED IF MY CANCER HAS SPREAD?

Current evidence suggests that in some patients in whom tumour has spread, removing the primary cancer in the kidney can extend life. Patients with metastatic kidney cancer need to be evaluated to determine how risky the surgery would be. If possible, it may be best to have a minimally invasive removal to limit recovery time and reduce pain of surgery.

WHAT ARE THE CHANCES OF CURINGMY CANCER?

Most kidney cancers are cured with surgical removal. If the cancer has spread, it may be difficult to cure. CT scans are routinely performed in follow up to enable early detection of any recurrence in future.

HOW ARE KIDNEY TUMOURS REMOVED?

Traditionally, kidney tumours were removed through open surgeries with painful and large incisions. Today, open surgeries are being replaced by minimally-invasive surgeries using robots and laparoscopes, resulting in smaller incisions, less pain and faster recovery time.

WHY SHOULD I HAVE A PARTIAL NEPHRECTOMY AS OPPOSED TO A TOTAL KIDNEY REMOVAL?

Partial Nephrectomy for small tumours preserves part of the patients’ kidney while getting rid of the cancer or tumour. As a result, the patient keeps most of the kidney and often maintains better overall kidney function and lifespan.

WHAT TYPES OF QUESTIONS SHOULD I ASK MY SURGEON PRIOR TO KIDNEY SURGERY?

Consider the following questions to ask your surgeon:

Can kidney surgery be done robotically?

Kidney tumours removed robotically have the same outcomes as open surgery and results in quicker recovery times and significantly less pain.

Can I have a robotic partial nephrectomy for complex tumours instead of total removal or open surgery?

We uses robotic assistance to successfully perform partial nephrectomy for even the most complex tumours including tumours situated deep within the kidney and tumours adjacent to crucial vessels that supply blood to the kidney.

What formal training do your surgeons have in robotic and laparoscopic surgery?

Surgeons in Department of Urology at Max Hospital are well trained and experienced to do Robotic Surgeries. Robotic urological procedures are routinely done in the Department.

IF YOU HAVE TO OPEN UP THE PATIENT, ARE YOU EXPERIENCED IN OPEN KIDNEY SURGERY AS WELL?

Yes, most urologists are trained in performing open kidney surgery. We offer robotic, laparoscopic and open surgery for kidney cancer.

WHAT IS PARTIAL NEPHRECTOMY?

Some of kidney tumours, masses or complex cysts can be treated with a procedure called Partial Nephrectomy, which is the surgical removal of the cancerous section of the kidney. In this procedure, a very minimal portion of the normal kidney is removed with the tumour and the vast majority of the healthy kidney tissue is spared and surgically repaired so blood and urine can flow normally. This is sometimes called “nephron-sparing” or “kidney sparing surgery.”

WHAT IS THE BENEFITS OF ROBOTIC ASSISTED PARTIAL NEPHRECTOMY?

Robotic-Assisted Partial Nephrectomy allows the removal and reconstruction of the kidney to be performed through multiple keyhole-sized incisions, as opposed to a single open incision measuring several inches across the side of the abdomen. This large incision with open surgery typically is painful and may require partial removal of a rib. Although laparoscopic Partial Nephrectomy can also be performed using smaller incisions, it can be technically challenging – so these procedures are more often converted to a total Nephrectomy.

During the robotic procedure, urologist may temporarily halt blood flow to the affected kidney before cutting away the cancerous area. The magnified view of the kidney and the ideal positioning of the surgical instruments allow the surgeon to work with great precision and control when removing the kidney tumor, preventing bleeding, and then repairing the delicate vessels and tissues of the functioning kidney to be left behind. The tumour is removed from the body (after being placed in a small plastic bag) through one of the keyhole incisions.

As with most robotic-assisted procedures, there is typically far less pain compared to open procedure, less blood loss (and therefore less need for a blood transfusion), less scarring (both internally and externally), a shorter hospital stay (2 or 3 days versus up to a week), and shorter overall recovery time before a return to normal activities.

WHAT IS THE ADVANTAGES OF A PARTIAL NEPHRECTOMY?

Partial nephrectomy offers two main advantages: it may decrease the risk of long-term kidney failure, and also the partially preserved kidney acts as a reserve if the other kidney is damaged. Keeping as much healthy kidney tissue as possible may help you avoid the need for dialysis in coming years, especially if you have pre-existing high blood pressure and diabetes. Many studies show that cancer survival rates in patients having partial nephrectomy are equivalent to those seen in patients having radical nephrectomy; however, the patients having the kidney-sparing procedure also benefit from many other long-term health advantages and improved overall survival.

ARE UROLOGISTS AT MAX HOSPITAL EXPERIENCED ENOUGH TO DO ROBOTIC ASSISTED PARTIAL NEPHRECTOMY?

We are experienced enough in Robotic-Assisted Partial Nephrectomy and related procedures and treatments. We have performed many successful partial nephrectomies in patients who previously had been told that their whole kidney needed to be removed. We also are able to perform robotic kidney procedures in the vast majority of patients with risk factors (such as patients with obesity, multiple prior surgeries, older age, early spread of the tumour into blood vessels, or complex medical conditions) who might otherwise be told that they are not eligible for open or minimally invasive surgery.

WHAT IS ROBOTIC-ASSISTED RADICAL NEPHRECTOMY?

In cases where the kidney tumour is too large or problematic to spare the kidney, or in cases when the kidney no longer functions (sometimes due to non-cancer reasons), recommendations are complete surgical removal of the kidney. (Note that removal of just part of the kidney is always preferred, and we may be able to perform partial nephrectomy—even in patients with complex tumours who have been told by others that they require a total (or “radical”) nephrectomy.) The entire robotic-assisted procedure is performed through tiny keyhole-sized incisions, as opposed to a large open incision on the side of the abdomen—an incision that is often painful and requires partial removal of a rib.

The abdomen is first inflated with air (carbon dioxide) to provide the surgeon with enough space to move the colon away from the kidney. The surgeon identifies and clips off the blood vessels leading into the kidney so that blood flow is permanently halted. The kidney is then surgically removed from the bowels, liver, spleen, pancreas, and/or back muscles. In most cases, the adrenal gland is spared.

Once free, the kidney is specially bagged inside the body and then removed by a small incision which lies below the belt line. In some cases, nearby lymph nodes are also removed and examined (lymph node dissection) as part of the nephrectomy.

WHAT ARE ADVANTAGES OF ROBOTIC ASSISTED RADICAL NEPHRECTOMY?

As with most robotic-assisted procedures, there is typically much less pain than with the open procedure, less blood loss (and therefore less need for a blood transfusion), less scarring (both internally and externally), a shorter hospital stay (usual 1-2 days versus up to a week), and shorter overall recovery time before a return to normal activities.