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U.S. News and World Report: America's Best Hospitals, Urology, 2014-2015

 

Robotic Expansion to Kidney Surgery

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Kidney Cancer

Surgery is the mainstay of treatment for patients with kidney cancer, often providing excellent odds for a cure.

 

The Department of Urology is pleased to provide patients with the option of robotic kidney surgery. While robotic technology can be used to remove the whole kidney in a radical nephrectomy, it is particularly well-suited to surgeries where only part of the kidney is removed—a partial nephrectomy—removing a cancerous tumor while leaving the healthy kidney behind.

 

In many cases, removing the tumor can protect overall kidney function while providing the same benefits as removing the whole kidney. Historically, partial nephrectomies were only performed through an “open” approach, using a large incision under the rib cage.

 

Drs. Jason Abel and Sara Best utilize leading-edge technology to treat kidney cancer, including using the da Vinci robot to perform partial nephrectomies.Robotic kidney surgery involves smaller “keyhole” incisions that allow the patient to recover more quickly. Robotic laparoscopic partial nephrectomy is typically performed with about five small incisions, each less than ½-inch long. One of these incisions may be enlarged slightly to remove the tumor specimen.

 

The da Vinci robotic camera provides highdefinition, three-dimensional imaging for the surgeon. The robotic surgical arms provide “wristed” movements that can help the surgeon precisely cut out the tumor and then “reconstruct” or rebuild the kidney after the tumor is removed.

 

The same aspects of robotic technology that make it helpful in partial nephrectomy can also make a reconstructive kidney operation easier. One such procedure, called a pyeloplasty, involves the repair of a kidney blockage called a ureteropelvic junction obstruction. This obstruction is surgically excised and the ureter is sewn back together. The robotic wristed instruments can facilitate precise placement of these sutures.

 

The Department of Urology is pleased to provide one of the newest kinds of kidney surgery, called robotic laparo-endoscopic single site surgery (R-LESS). Rather than using multiple small incisions, in R-LESS, the entire procedure is done through one small incision hidden inside the belly button. In select patients, this type of procedure can result in “scarless” surgery. R-LESS surgery is performed at a limited number of centers worldwide, including UW Hospital and Clinics.

 

Potential advantages of the R-LESS approach include improved cosmetic outcomes and perhaps a shorter recovery period. Benefits of all types of robotic kidney surgery include shorter hospital stay, less pain and scarring, faster recovery and a quicker return to normal activities.

 

References

 

Abel EJ, Lloyd GL, Sivalingam S, Williams MB. Robotic Assisted Partial Nephrectomy. eMedicine from WebMD. In press.

 

Gill IS, Kavoussi LR, Lane BR, et al: Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors.  J Urol  2007; 178:41-46.

 

Huang et al, 2006. Huang WC, Levey AS, Serio AM, et al: Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study.  Lancet Oncol  2006; 7:735-740.

 

Seideman CA, Tan YK, Faddegon S, Park SK, Best SL, Cadeddu JA, Olweny EO. “Robot-Assisted Laparoendoscopic Single-Site Pyeloplasty: Technique Using the da Vinci Si Robotic Platform.” J Endourol. 2012 Apr 17. [Epub ahead of print]

 

Olweny EO, Park SK, Tan YK, Gurbuz C, Cadeddu JA, Best SL. “Perioperative comparison of robotic assisted laparoendoscopic single-site (LESS) pyeloplasty versus conventional LESS pyeloplasty.” Eur Urol. 2012 Feb;61(2):410-4.

 

Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, Desai MM, Gill IS. “Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison.”  Eur Urol. 2010 Jan;57(1):95-101.

 

Afaneh C, Aull MJ, Gimenez E, Wang G, Charlton M, Leeser DB, Kapur S, Del Pizzo JJ. “Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes.” Urology. 2011 Dec;78(6):1332-7.