The Kidney tumors are increasingly 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 reason.
Thanks to this early diagnosis, kidney 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 functioning renal parenchyma. The Robotic surgery allows us to improve the results of this type of kidney-conserving 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 ureteropelvic junction stenosis). , pelvic floor prolapses, etc.).
What is robotic surgery and what does it consist of?
Robotic surgery is performed using 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 gets a three-dimensional view of the patient's interior and the movements he makes on the console controls are transmitted to the robotic arms that are inside the patient. These arms carry 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 help during it.
The access for robotic surgery They are similar to those of laparoscopic surgery, the fundamental difference is the range of motion of the da Vinci robot, which resembles that of the surgeon's hand.
Surgery to treat kidney cancer
The main kidney cancer treatment It's 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. Kidney cancer surgery consists of removing the kidney 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 resorted to?
There are other treatment options for kidney cancer such as percutaneous ablation or even in some very selected cases, close surveillance can be carried out without the need to perform any intervention on the tumor. However, each case must be individualized and treatment must be adapted for each patient. Despite all this, nephrectomy remains until now the most effective treatment for treating 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 surgery. kidney transplant.
Radial nephrectomy consists of complete kidney removal. This technique is reserved for cases in which kidney-conserving surgery cannot be performed. It is also necessary in some benign pathologies such as the functional annulment of a kidney or even large benign tumors.
The surgical technique consists of sectioning the vessels that nourish the kidney and ureter. The surgical piece 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 consists of remove the kidney tumor completely while preserving as much healthy kidney tissue as possible. Thanks to this, kidney function is better preserved, thus avoiding the need for dialysis. It is the technique of choice for small kidney tumors, diagnosed early.
The surgical technique consists of temporarily closing the flow of the renal artery to excise the tumor and subsequently suture the remaining defect.
It is important to know that despite undergoing a partial nephrectomy, there is always the risk that there will be a need to perform a radical nephrectomy.
In most cases, the preferred surgical approach to perform this surgery is robotic surgery since it provides great advantages, but it can also be performed through laparoscopic surgery.
Advantages and benefits of nephrectomy to treat kidney tumors
In the case of partial nephrectomy, the approach through da Vinci robot-assisted laparoscopic surgery has multiple advantages:
- It allows us to have a three-dimensional vision and thus better delimit the lesion and its edges.
- It allows us to remove the lesion with more precision, thus reducing the rate of positive margins.
- It allows us to suture the defect that remains in the renal parenchyma more safely to avoid bleeding in the postoperative period.
- All of the above helps reduce the ischemia time necessary to safely perform tumor excision and repair of the kidney defect, which translates into a lower risk of damage to kidney 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 operating time and the greater safety of the surgical technique.
Urologists specializing in robotic surgery in Madrid
The Ramírez Urology team at Hospital Ruber Internacional has more than 15 years of experience in minimally invasive surgery using the da Vinci robot, being leaders in the specialty of urology.