Renal tumors are increasingly being diagnosed at earlier stages thanks to access to imaging tests such as ultrasound. Most kidney tumors are diagnosed incidentally when an imaging test is performed for another cause.
Thanks to this early diagnosis, renal tumors are usually small in size when they are discovered. This allows us to perform increasingly conservative surgeries that avoid the loss of the kidney and the functioning renal parenchyma. Robotic surgery allows us to improve the results of this type of conservative kidney surgery thanks to its multiple advantages compared to traditional surgery.
The da Vinci robot has not only been shown to optimize the results of surgical treatments for oncological pathologies such as prostate, kidney or bladder cancer, it has also been shown to improve surgical results in reconstructive procedures (such as the treatment of pyeloureteral junction stenosis, pelvic floor prolapses, etc.).
What is robotic surgery and what does it consist of?
Robotic surgery is performed using the Da Vinci Xi clinical robotic surgical system. This robot consists of three fundamental parts, the console, the robotic arms and the tower, all of which are connected to each other to function as a unitary system. The surgeon performs the surgery from the console, where he has a three-dimensional view of the patient's interior and the movements he makes on the console controls are transmitted to the robotic arms inside the patient. These arms carry the robotic instruments that reproduce the surgeon's precise movements. The tower also has a screen through which the surgical assistant observes the surgery and allows him to assist during the surgery.
The approaches for robotic surgery are similar to those for laparoscopic surgery, the fundamental difference being the range of motion of the da Vinci robot, which resembles that of the surgeon's hand.
Surgery to treat kidney cancer
The main treatment for renal cancer is surgery. With it, very high rates of remission of the disease are achieved and in most cases it is not necessary to apply other treatments. Renal cancer surgery consists of removing the renal tumor while preserving the rest of the healthy kidney (partial nephrectomy) or in cases where this is not possible it would be necessary to remove the entire kidney (radical nephrectomy).
When should nephrectomy be performed?
There are other treatment options for kidney cancer such as percutaneous ablation or even in some very selected cases, close surveillance can be performed without any intervention on the tumor. However, each case must be individualized and treatment must be tailored to each patient. In spite of all this, nephrectomy remains to date the most effective treatment for kidney tumors.
Kidney surgery is not only performed in oncological cases, it is also necessary to treat benign pathologies, injured kidneys or even prior to kidney transplantation. renal transplantation.
Radical nephrectomy
Radial nephrectomy consists of the complete removal of the kidney. This technique is reserved for cases in which conservative kidney surgery cannot be performed. It is also necessary in certain benign pathologies such as the functional cancellation of a kidney or even for large benign tumors.
The surgical technique consists of sectioning the vessels that nourish the kidney and ureter. The surgical specimen will be removed through an incision in the abdomen.
In most cases the preferred surgical approach to perform this surgery is laparoscopy, but in selected cases it is necessary to perform it through a traditional incision (open surgery).
Partial nephrectomy
Partial nephrectomy consists of removing the entire kidney tumor while preserving as much healthy kidney tissue as possible. As a result, renal function is better preserved, thus avoiding the need for dialysis. It is the technique of choice for small renal tumors diagnosed at an early stage.
The surgical technique consists of temporarily closing the flow of the renal artery to perform the exeresis of the tumor and then suturing the remaining defect.
It is important to know that despite undergoing a partial nephrectomy, there is always a risk that a radical nephrectomy may be necessary.
In most cases the preferred surgical approach to perform this surgery is robotic surgery as it provides great advantages, but it can also be performed by laparoscopic surgery.
Advantages and benefits of nephrectomy for treating kidney tumors
In the case of partial nephrectomy, the da Vinci robot-assisted laparoscopic approach has multiple advantages:
- It allows us to have a three-dimensional view and thus better delimit the lesion and its borders.
- It allows us to remove the lesion with more precision, thus decreasing the rate of positive margins.
- It allows us to suture the defect remaining in the renal parenchyma more safely to avoid postoperative bleeding.
- All of the above helps to reduce the ischemia time necessary to safely perform tumor exeresis and repair of the kidney defect, which translates into less risk of damage to renal function.
- Since it is a minimally invasive approach, postoperative recovery is faster, with less hospitalization time and less pain.
The main difference with conventional approaches is the operative time and the greater safety of the surgical technique.
Urologists specialized in robotic surgery in Madrid
The Ramirez Urology team at Hospital Ruber Internacional has more than 15 years of experience in minimally invasive surgery using the da Vinci robot. minimally invasive surgery using the da Vinci robot, being a reference in therobot, being a reference in the specialty of urology.
