Robot-assisted partial or radical nephrectomy uses the Da Vinci surgical system to enable the surgeon to operate by controlling a series of robotic arms through small incisions in order to remove a portion (partial) or the entire kidney (radical) in patients with a kidney tumor.
Robot-assisted procedures enable dramatically faster recovery than traditional open surgery. Certain patient and tumor characteristics may prevent a robot-assisted approach.
When to Ask a Urologist about Robot-Assisted Partial / Radical Nephrectomy
You should speak with a Urologist about Robot-Assisted Partial / Radical Nephrectomy if a kidney tumor has been identified on imaging.
Cost
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Effectiveness
Surgical removal of a kidney cancer by either partial nephrectomy or radical nephrectomy has an excellent chance of being curative if the kidney cancer cells have not spread to other parts of the body. Very few patients require additional treatment such as chemotherapy or radiation. Outcomes vary depending on the type of underlying kidney cancer and whether partial or radical nephrectomy was performed. In general, the risk of a local recurrence is about 2% following partial nephrectomy and about 1% following radical nephrectomy. The average 5-year cancer-specific survival for a surgically treated kidney cancer is over 95%.
Possible Side Effects
The risks associated with kidney tumor removal include bleeding (with the possible need for transfusion), infection, failure to remove all of the cancer, renal insufficiency with the potential for future renal failure (dialysis), damage to adjacent structures, delayed bleeding, urine leak, the chance that the renal tumor could be benign, hernia, stroke, heart attack, blood clot, and a small (<1%) possibility of death.
Alternative Approaches
Surgical removal is the gold standard management strategy for kidney tumors, and the majority of tumors are treated surgically. Other options include ablation (destruction of the tumor without removal by either heating or freezing) or radiographic surveillance (typically used in older patients with very small tumors).
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive, and you should wash the surgical area with an antibacterial soap. You may be instructed to drink one bottle of magnesium citrate to evacuate the bowels in preparation for the procedure.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The surgery typically requires hospitalization for about two nights. Patients have a catheter draining their bladder that is usually removed prior to discharge unless a segment of bladder had to be removed with the kidney. There may be an additional external surgical drain also removed prior to discharge. Light activity, including walking, under nursing supervision is recommended. The nursing staff will also provide teaching to use a breathing device called an incentive spirometer that helps encourage patients to take deep breaths. Patients may begin drinking liquids following surgery and can slowly advance to more solid food as tolerated. It is common to have abdominal discomfort and bloating.