What is laparoscopic robotic partial nephrectomy and when should it be considered?

Robotic PARTIAL NEPHRECTOMY (Nephron sparing surgery)

See more about kidney cancer here.

With the increased use of cross-sectional imaging, small incidentally detected renal tumours are common in general practice. In a patient without multiple co-morbidities, surgical treatment of the tumour offers definitive curative treatment. Removing the tumour alone, instead of the entire kidney when technically feasible, allows for preserving kidney function without compromising oncological control.

Although partial nephrectomy via open incision is an established method for the treatment of such renal lesions, given the morbidity associated with a large incision, pain, lengthy hospital stay, and long recovery time, it is not often employed. In contrast, laparoscopic radical nephrectomy has become the most widely performed kidney surgery. In rare occasions, open partial nephrectomy is still considered the better approach for specific scenarios.

Considering that many patients with a renal mass have co-morbidities, including hypertension, diabetes, abnormal cholesterol profile, and so on, it is prudent to preserve as much renal function as possible by not removing the unaffected nephrons. 

Robotic partial nephrectomy is an excellent method for treating small renal tumours, and some selected larger tumours. As well as safely removing the mass and preserving the kidney, the benefits of a minimally invasive approach will mean a reduction in pain, faster recovery, and an earlier return to normal function for the patients.

This video shows a robotic partial nephrectomy for a large cystic renal tumour by A/Prof Homi Zargar.

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The wrist articulation and 3D magnified vision allow the surgeon to perform complex surgery in a minimally invasive fashion, recapitulating the open technique. During the procedure, the blood flow to the kidney is interrupted, the tumour is excised, the kidney is reconstructed, and blood flow is re-established (watch a short video here). Typically, only 10-15% of the renal parenchyma is removed, and the patient is often discharged the subsequent day. Patients can return to normal activities within two weeks of the surgery. 

Available data suggests that compared to the pure laparoscopic approach, robotic partial nephrectomy is associated with lower complications and better outcomes; however, in expert hands, the results from both techniques are comparable. A/Prof Zargar has a great deal of experience in both methods.

A/PROF Zargar was trained for this procedure at the Cleveland Clinic, one of the world’s leading institutions for this technique. As well as technical expertise, A/PROF Zargar is an expert in renal preserving surgery with over 50 publications in peer-reviewed journals on this topic. Homi offers minimally invasive partial nephrectomy in public and private settings. He has extensive expertise in renal preserving surgery and is one of the highest-volume surgeons in Victoria concerning this surgery. Based on this experience, where surgery is being contemplated, more than 90% of renal masses less than 4 cm and up to 50% of tumors measuring 4-7 cm can be treated with partial nephrectomy, and removal of the entire kidney can be avoided.

If you or someone you know has been diagnosed with a renal lesion (mass, cancer), please reach out and discuss your case to see if renal preservation surgery is a suitable option for your condition.