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Kidney Surgery

Procedure overview

There are two types of kidney surgery; radical (complete) nephrectomy, and partial nephrectomy. During a radical nephrectomy, the urologic surgeon removes the entire kidney and often some additional structures, such as part of the tube that connects the kidney to the bladder (ureter), or other adjacent structures such as the adrenal gland or lymph nodes. In a partial nephrectomy, also called kidney-sparing (nephron-sparing) surgery, the surgeon removes diseased tissue from a kidney and leaves healthy tissue in place.[1]

A nephrectomy may be performed through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen using a camera and small instruments (laparoscopic nephrectomy). Robotic assisted nephrectomies are used in combination with laparoscopic, or exclusively as a minimally invasive option. The most common reason a urologic surgeon performs a nephrectomy is to remove a tumor from the kidney. These tumors are usually cancerous, but they can be noncancerous (benign). Other Kidney diseases, and damage may also require patients to undergo a nephrectomy.

Figure 1. Open vs Robotic, Port Placement for Partial Nephrectomy Surgery

Surgeons will choose a minimally invasive option whenever possible to reduce surgery time, bleeding during surgery, pain and so patients have a shorter hospital stay.  Robotic assisted surgery has been shown to reduce blood loss, complications, and hospital stay compared with both laparoscopic and open surgery techniques.[2],[3]

Learn more about what robotic assisted surgery is and how surgeons use the technology here.

Potential Benefits​

Studies on Robot assisted partial nephrectomy have reported the following results:

  • Robot assisted partial nephrectomy has been shown to offer fewer blood transfusions[4], shorter operative time[4], faster recovery time[4], and less peri-operative complications in obese  patients compared to the open approach[4].
  • Additional studies have showed shorter length of stay, fewer perioperative complications, and less blood loss compared to the open approach[5].

Additional Patient Resources

Visit the the Canadian Cancer Society for more informational about the disease, diagnosis, treatment options and support available.

Community Groups

Educational Videos

Dr. Geoffrey Gotto of Rockyview General in Calgary discusses the difference between robotic and laparoscopic surgery. [Video source: kidneycancercanada.ca Video Knowledge Library]

Dr. Stephen Pautler of St. Josephs Health Care London answers a series of questions about robotic assisted surgery. [Video source: kidneycancercanada.ca Video Knowledge Library]

Agnes, a patient of Dr. Ricardo Rendon at QEII Hospital in Halifax, describes her experience with kidney cancer and successful treatment with Robot Assisted Surgery.

 

KCC Toronto Patient Meeting Presentation by Dr. Tony Finelli in 2015

Kidney Cancer Canada Patient Meeting held in September, 2014 at the Juravinski Cancer Centre. Presentation “Management of Kidney Cancer” by Dr. Anil Kapoor

Kidney Cancer Canada Patient Meeting held in October, 2014 at the BC Cancer Agency. Presentation “Surgical Management of Renal Cell Carcinoma” by Dr. Peter Black

Risks & Considerations

Not everyone is a candidate for robotic assisted procedures, and other treatment options may be available and appropriate. Only a doctor can determine whether robotic assisted surgery is appropriate for a patient’s situation. Surgery of any form contains risks and it is important to discuss risks with your provider. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision. 

Patients have also developed support areas where they are able to speak with each other about the surgery, their experiences, and any issues that they have faced during their treatment. To learn more check out the additional resources above or visit the community section of this website. 

[1]https://www.mayoclinic.org/tests-procedures/nephrectomy/about/pac-20385165#:~:text=The%20most%20common%20reason%20a,because%20of%20other%20kidney%20diseases.

[2] Kara, O., Maurice, M., Malkoc, E., Ramirez, D., Nelson, R., Caputo, P., Stein, R. and Kaouk, J., 2016. Comparison of robot-assisted and open partial nephrectomy for completely endophytic renal tumours: a single centre experience. BJU International, 118(6), pp.946-951.

[3] Shen, Z., Xie, L., Xie, W., Hu, H., Chen, T., Xing, C., Liu, X., Xu, H., Zhang, Y., Wu, Z., Tian, D. and Wu, C., 2016. The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis. World Journal of Surgical Oncology, 14(1).

[4]Malkoc, E., Maurice, M. J., Kara, O., Ramirez, D., Nelson, R. J., Caputo, P. A., … Kaouk, J. H. (2016). Robot-assisted approach improves surgical outcomes in obese patients undergoing partial nephrectomy. 119(2), 283–288. https://doi.org/10.1111/bju.13675

[5] Shen, Zhonghua, et al. “The Comparison of Perioperative Outcomes of Robot-Assisted and Open Partial Nephrectomy: A Systematic Review and Meta-Analysis.” World Journal of Surgical Oncology, vol. 14, no. 1, 22 Aug. 2016, 10.1186/s12957-016-0971-9.https://www.prostatecentre.com/patient-information/diseases-prostate/prostate-cancer/treatments/prostatectomy