Robotic Partial Nephrectomy

Robotic-assisted partial nephrectomy may be an option for patients with:

• A benign or cancerous kidney tumour
• Kidney tumour smaller than 4cm diameter, or multiple small tumours
• A tumour that is 5-7cm diameter may be suitable depending on the position within the kidney
• Severely damaged or diseased kidney tissue that requires removal, where the entire kidney is not affected

If it deemed appropriate, a robotic-assisted partial nephrectomy is advantageous to the patient since it enables preservation of the healthy kidney tissue, rather than removing the entire kidney. This may result in a lower risk of kidney failure in the long term.

Robotic-assisted partial nephrectomy offers both the surgeon and the patient various benefits when compared to conventional laparoscopic or open surgery.

The patient benefits from:

• Smaller incisions
• Shorter blood cut-off time (ischemia) to the kidney
• Less blood loss
• A shorter hospital stay and faster recovery time

The surgeon benefits from:

• Greatly enhanced, high definition 3D vision inside the body
• Small and precise instruments that allow a greater range of movements than the human hand

• The patient is placed under general anaesthetic for the duration of the procedure, which lasts around 3 hours
• Between 3-5 small keyhole incisions are made in the abdomen, through which the surgical tools and camera are inserted
• Carbon dioxide is used to inflate the patient’s abdomen, creating space required for the surgeon to view and access the affected kidney in detail
• Under the control of the surgeon, the blood flow to the affected kidney is temporarily interrupted (in most cases)
• The affected kidney tissue or tumour is carefully removed from the kidney
• The incision or cut in the kidney is meticulously sutured back together and blood flow to the kidney is restored
• Carbon dioxide is released and the robotic instruments are removed
• Incisions are sealed carefully, to reduce the chance of hernia or scarring

• You may remain in hospital for 2-3 nights following your procedure
• There may be some mild pain or discomfort which will be managed with medication
• You will be encouraged to sit out of bed and walk around as well as perform deep-breathing exercises to minimize the chance of pneumonia or blood clots in the legs or lungs (DVT/PE)
• Uncommon complications include:
  • Leakage of urine into the abdomen from the kidney incision
  • Damage to major blood vessels during surgery
  • Incisional hernia (usually where there are problems with wound healing)

Robotic-assisted partial nephrectomy offers patients the ability to maintain good kidney function, through preservation of their healthy kidney tissue. Most patients are able to return to their normal activities within 2-3 weeks following a robotic-assisted partial nephrectomy. Strenuous activities and heavy lifting should be avoided for 6 weeks following surgery to minimize the chance of bleeding or hernia.

Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa

Rogers, C. G., Singh, A., Blatt, A. M., Linehan, M., Pinto, P. A., (2008), Robotic partial nephrectomy for complex renal tumours: surgical technique, European Urology ,53(3), [https://www.sciencedirect.com/science/article/abs/pii/S0302283807012493], accessed 27/02/21.