Robotic Partial Nephrectomy

Partial Nephrectomy Open vs robotic incisions

Partial nephrectomy is possible for small kidney tumours of < 4 cm. When done for cancerous tumours, it offers the same rate of cure as total nephrectomy while conserving as much normal kidney tissue. The standard method is open surgery but would result in long scar, prolonged wound pain, slower recovery and long-term numbness/ muscle bulge. Standard laparoscopy avoids these sequelae but is technically difficult to perform, with a high chance of conversion to open surgery.

Tumour located with aid of laparoscopic ultrasound

Robotic method gives the benefit of faster, more precise and water-tight repair of the kidney defect with lower chance of conversion to open surgery.

Robotic arms in position Dr Chin doing surgery on latest Xi robot
Steps in partial nephrectomy

For partial nephrectomy the blood flow to the kidney has to be interrupted. However, it is imperative to limit this time to a minimum as kidney function deteriorates quickly after 30 minutes of ischaemia. The robotic system reduces the time needed to repair the defect, thanks to the dexterity and precision of the instruments. It is important to control the bleeding vessels to reduce blood loss, and close the defect in a water-tight fashion to reduce the risk of urine leak. The surgery takes 3 to 4 hours and requires a highly specialized team.

Complications include:

  • Bleeding. Blood loss is generally limited (< 500 ml) but blood transfusion may still be needed if the bleeding is excessive.
  • Urine leak. This occurs if the defect is not repaired in a water-tight fashion. This will result in fever, pain and bloatedness in the immediate post-op period. If the urine leak is excessive, a double-J stent may need to be inserted.
  • Conversion. As with all laparoscopic techniques, conversion to open surgery is always possible if difficulty is encountered or bleeding is excessive
  • Remnant tumour. Cancerous tissue can be left behind if the tumour is violated during its excision. The histology will report a ‘positive margin’. If so, surveillance MRI scan is needed. If recurrent cancer is subsequently demonstrated, nephrectomy is recommended.
  • Kidney atrophy. This occurs if the ischaemic time goes beyond 45 mins.

Desired outcomes:

  • No blood transfusion (up to 20% of cases )
  • No urine leak ( < 5% risk )
  • No conversion to open surgery (< 10%)
  • Ischaemia time < 25 mins
  • No positive margins / recurrence of tumor ( 3% chance )

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