Understanding Robotic Partial Nephrectomy
Surgery is generally the first line treatment for localized kidney cancer
(cancer that has not spread). Removal of kidney tumors can be done using
larger open incisions or through minimally invasive approaches such as
laparoscopic or robotic surgery. These minimally invasive approaches give
equal cancer control to that of open surgery and make for an easier
recovery after surgery. At BIDMC, because of our extensive training and
experience in these techniques, nearly all kidney cancer surgery is able to
be performed laparoscopically or robotically. Over 95% of our partial
nephrectomies in 2014 were performed robotically, a much higher rate than
most other institutions. Additionally, greater than 95% of our radical
nephrectomies in 2014 were performed using laparoscopy, sparing our
patients a larger painful incision through the ribs and potentially weeks
or months of recovery.
Partial nephrectomy is the removal of part of the kidney, usually because
of a tumor, while sparing the remainder from damage or removal. It
typically is performed if the renal tumor is less than 7-cm or the patient
has only one kidney. Traditionally, this procedure has been performed as an
open surgery through an 8-12 inch incision in the flank, requiring removal
of one of the patient's ribs. (see figure 1a and 1b)
partial nephrectomy is a minimally invasive alternative, performed with
thin, specialized instruments inserted through tiny incisions; the surgeon
does not need to place his/her hand inside the abdomen. This results in a
cancer cure rate equal to that of open surgery, but with far less pain and
much quicker recovery.
Minimally invasive surgery is part of BIDMC's multidisciplinary approach to
kidney cancer. To learn about the comprehensive treatment options available
through our Renal Tumor Clinic, please
Robotic partial nephrectomy utilizes an operating telescope and thin,
specialized instruments placed in the abdomen through 3-4 "keyhole"
incisions, each 1cm. The blood supply to the kidney is temporarily
interrupted to allow for tumor removal without excessive bleeding. The tumor is then carefully dissected free from the kidney, and the
defect in the kidney is repaired using robotic suturing techniques. (See figure 2.) The tumor is placed inside a retrieval bag and
removed through one of the incisions.
Advantages over open surgery
Improved visualization of surgical field
Shorter hospital stay
Better cosmetic result
Lower transfusion rates
Fewer wound hernias
Robotic partial nephrectomy controls cancer equally as well as the
traditional open procedure.
Typical blood loss is 200-300cc. Blood transfusions are extremely rare.
What to Expect after Surgery
The typical hospital stay is 2 days.
Patients resume normal eating as they recover in the first day after
surgery or soon thereafter.
Pain is managed immediately with an intravenous patient controlled
analgesia pump, which is removed and replaced by pills the day after
surgery. Upon discharge, pain pills are given for several days, after which
over-the-counter acetaminophen or ibuprofen are usually all that is needed.
A urinary catheter is left in place for two days following the surgery and
A small drain is placed in the area of the kidney and is usually removed
the second day after surgery.
Most patients are able to return to full activity within 4-6 weeks compared
with 8-12 weeks for open partial nephrectomy.
Patients will follow-up with their surgeon one month after the operation
for a routine visit, then at 12 and 24 months with CT scans of the kidney
to monitor for recurrence. Appointments can easily be conducted over the
phone for patients living outside the Boston area, including international