What is a partial nephrectomy?
A partial nephrectomy is a surgical procedure during which the urological surgeon removes a cancerous or benign (non-cancerous) tumour from the kidney. The healthy kidney tissue is left in place, so this is sometimes known as a kidney (nephron)-sparing procedure.
At Melbourne Urology Centre partial nephrectomy is often performed as a minimally-invasive approach. It is performed through keyhole incisions, much of the time using the robotically-assisted Da Vinci platform. Partial nephrectomy preserves the healthy part of the kidney tissue, which offers patients a lower risk of kidney failure in the longer term.
When is a partial nephrectomy performed?
The most common reason why a urological surgeon may perform a partial nephrectomy is to remove a small tumour from the kidney. This type of surgery is usually reserved for tumours that are 4cm in size or smaller, but on occasions, larger tumours (5-7cm) may also be removed from the kidney using this technique, depending on tumour location and complexity.
In patients who have larger tumours or the tumour is located in a difficult anatomical position, partial nephrectomy may not be feasible or safe. In these cases often a complete (radical) nephrectomy is indicated.
How is a partial nephrectomy performed?
Partial nephrectomy can be performed either by traditional open surgery (uncommon), laparoscopically (through keyhole incisions), or robotic-assisted laparoscopic surgery, using the state of the art da Vinci robot.
Dr Tony de Sousa and Dr Shekib Shahbaz of Melbourne Urology Centre are fully trained and highly experienced in performing robotic-assisted partial nephrectomy. Robotic-assisted surgery offers numerous benefits to both the patient and the surgeon. It is worthwhile noting that the surgeon is in control of the robot at all times; it is best to think of the robot as a highly dexterous extension of the surgeon’s arm.
What happens during a robotic partial nephrectomy?
Partial nephrectomy is performed under general anaesthetic. The operating time can vary considerably between cases. Generally this type of surgery takes around 3-4 hours to perform. Keyhole incisions are made in the patient’s abdomen, through which the robotic instruments and a specialised 3D camera are inserted.
Under the control of the surgeon, the robotic instruments are used to meticulously remove the tumour with minimal blood loss. At the completion of the partial nephrectomy, the keyhole incisions are closed leaving minimal scarring.
What are the advantages of having a robotic partial nephrectomy?
Having the partial nephrectomy performed robotically offers both the patient and the surgeon a number of benefits.
For the urological surgeon, the da Vinci robot offers:
- High definition 3D vision inside the patient’s body
- The ability to perform very small and precise maneuvers, as the robotic instruments have a greater range of motion and dexterity that the human hand
- Overall greatly enhanced vision and precise control of the surgical instruments.
For the patient, the da Vinci robot offers:
- Less trauma: robotic partial nephrectomy requires smaller incisions and does not involve the surgeon cutting through bone or muscle tissue
- Shorter blood cut-off (ischaemia): the blood supply to the kidney is restricted for less time with robotic partial nephrectomy, compared with conventional laparoscopy, which in turn reduces the risk of long-term kidney damage
- Less blood loss: there is significantly less blood loss associated with robotic partial nephrectomy compared with traditional surgery
- Quicker recovery time: with all of the benefits mentioned above, the patient experiences a faster recovery time compared with those who undergo conventional surgical methods.
What to expect after a partial nephrectomy?
Most patients stay in hospital for 2-3 nights following their partial nephrectomy. Mild pain or discomfort may be present, but this can be managed with medication. Your medical staff will encourage you to sit out of bed and move around, as well as performing deep breathing exercises in order to minimize the risk of pneumonia or blood clots in the legs or lungs (DVT).
Most patients are able to return to their normal activities within 2-3 weeks following their partial nephrectomy. Strenuous activity and heavy lifting should be avoided for 6 weeks following the procedure to minimize the chances of hernia or bleeding.
All surgeries, including partial nephrectomy, carry risks. Some of the very rare, but possible risks of partial nephrectomy include:
- Leakage of urine into the abdominal cavity
- Damage to the blood vessels or internal organs during the surgery
- Air entering the chest cavity (pneumothorax)
- Kidney failure, in cases where the remaining kidneys fail to function well.
These possible, but very rare risks are in addition to the general risks associated with general anaesthesia, excessive or uncontrollable bleeding, blood clots and infections, all of which your urological surgeon will be able to discuss with you.
Partial nephrectomy at Melbourne Urology Centre
At Melbourne Urology Centre, your condition will be thoroughly assessed and evaluated by our specialist urologists, who will be able to determine whether a partial nephrectomy is an appropriate procedure for you. Our experienced surgeons specialise in robotic laparoscopic procedures, using the da Vince robot, therefore providing our patients with the best chance of a successful outcome.
If you would like further information on partial nephrectomy, or have any other questions, you may contact us at Melbourne Urology Centre and our team of friendly and experienced staff will be able to assist you.