Robot in Kidney Cancers; Robotic Radical Nephrectomy, Robotic Partial Nephrectomy
What are the treatment options in kidney cancers?
There are 3 options for the complete removal of the kidney together with the surrounding fat tissue (radical nephrectomy): Open, laparoscopy and robotic surgery.
What are the disadvantages of open nephrectomy?
Large incisions are needed to completely remove the kidney with open surgery. Sometimes in large kidney cancers, it may be necessary to remove the 12th rib to remove the mass. Due to these muscles and nerves injured after the surgery, there is a long-term pain and numbness at the incision site, and the wound heals late. In addition, an incisional hernia that may develop may adversely affect the patient's quality of life.
What is laparoscopic nephrectomy?
In this technique, the same procedures are performed in open surgery by using telescopes and thin surgical instruments inserted into the body through working channels (trocars) placed through only 3 or 4 holes. However, since this process is done in two dimensions, it is a process that is difficult to learn and requires experience.
How is robotic kidney cancer surgery performed?
Robotic kidney cancer surgery is started with the classical laparoscopic method. First, 4 incisions smaller than one centimeter are made in the abdomen of the patient. Afterwards, trocars are inserted through these incisions to allow the robot arms to reach the abdomen. The tumor tissue or tissues to be removed from the inside after the surgery are placed in a special bag. The small incisions made are slightly enlarged and taken out from this area.
What are the advantages of robotic kidney cancer surgery?
There is much less bleeding in robotic kidney cancer surgery compared to other methods. Since a long incision is not made to the patients, the postoperative pain and pain relief needs of the patients are less. Patients return to their normal daily lives in a much shorter time. The scars on the patients' bodies are smaller. After the cancerous tissue is removed, the functions of the remaining kidney tissue are better preserved. Deformities and hernias that may occur in the operation area after open surgeries do not occur after robotic surgery operations.
What is robotic partial nephrectomy surgery?
Robotic method: With its 3-dimensional, high resolution, 12 times larger image and features that eliminate the trembling effect of the surgeon's hand, the tissues are displayed in more detail and the separation of cancerous and non-cancerous tissues is provided more perfectly. Cancer surgery results of open, laparoscopic, and robotic techniques in nephrectomy in which the kidney is completely removed are similar. However, robotic surgery has become a highly preferred method in the operation we call partial nephrectomy, in which the cancerous part of the kidney is removed, and the healthy parts are left (figure 1). This method can be easily applied especially in kidney tumors with a diameter of 4 cm or less (figure 2).
Figure 1: In the robotic partial nephrectomy technique, only the cancerous tissue in the kidney is removed and the intact kidney tissue is preserved.
Figure 2: Cancer tissue with a mass of approximately 4 cm in the left kidney (red arrow in the left image) and removed by robotic partial nephrectomy surgery.
However, with the effect of experience gained in robotic surgery, this method has become applicable to kidney masses with a diameter of 6-7 cm (figures 3 and 4). In addition, the robot makes our work much easier in repairing the tissue space formed after the tumorous area in the kidney and the injured vessels and urinary channels are repaired.
Figure 3: Position of the patient and placement of trocars for robotic right partial nephrectomy.
Figure 4: Cancer tissue removed by robotic partial nephrectomy from a patient with a mass of approximately 7 cm in his right kidney (white arrow on the right)
What are the risks and complications of robotic kidney cancer surgery?
Like all other surgeries, robotic kidney cancer surgery has some risks related to anesthesia. To evaluate and minimize these risks, all patients are evaluated by the anesthesiologist before surgery. Some complications may also develop due to this surgery. Although it is planned to remove only a part of the kidney for various reasons, the entire kidney may need to be removed. In addition, it may be necessary to return to open surgery due to possible adhesions and the device not working.
Is the doctor important in robotic kidney cancer surgery?
As in all urological surgeries, it is very important that the surgeon performing the surgery is experienced. After all, the one who controls the robot is a surgeon. For a successful and smoother operation, it is necessary to have an operation with a doctor who is specialized in robotic surgery.