Robotic Partial Nephrectomy

Partial nephrectomy is possible for small kidney tumours of < 4 cm. When done for cancerous tumours, it offers the same rate of cure as radical (total) nephrectomy, while conserving as much normal kidney tissue. The standard method is open surgery but the long scar, wound pain, slower recovery and long-term numbness/ muscle bulge below the wound is still a fear in most patients. Standard laparoscopy avoids these sequelae but can technically difficult to do, with a higher chance of still converting to open surgery.

Robotic partial nephrectomy gives the additional benefit of faster, more precise and water-tight repair of the kidney defect with lower chance of conversion to open surgery. In 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. Robotic technology reduces the time needed to repair the defect after the tumour is excised. The precision of the instruments give better control of bleeding and reduce the risk of urine leak from the defect.

The surgery takes 3 to 4 hours and requires a specialized team.

Complications include:

  • bleeding. Blood loss is generally limited (< 500 ml) but blood transfusion may still be needed.
  • urine leak. After cutting away the tumour, the defect must be repaired in a water-tight fashion. If not, urine can leak out of the kidney to cause fever, pain and bloatedness. If the urine 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, regular surveillance CT or MRI scan needs to be done. If recurrent cancer is subsequently shown, completion total nephrectomy is needed.
  • kidney atrophy. This occurs if the ischaemic time has gone 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 )

This animated video shows how robotic partial nephrectomy is performed -

Patient testimonial