What is laparoscopic robotic partial nephrectomy and when should it be considered?

RPN
 

Robotic Nephron sparing surgery

With an increase in use of cross sectional imaging, small incidentally detected renal tumours are a common scenario in general practice. In a patient without multiple co-morbidities, surgical treatment of the tumour offers definitive curative treatment. Removal of the tumour alone, instead of the entire kidney when technically feasible allows for preservation of kidney function without compromising oncological control.

Although partial nephrectomy via open incision is an established method for treatment of such renal lesions, given the morbidity associated with a large incision, pain, lengthy hospital stay and long recovery time, it is not often employed. In contrast, laparoscopic radical nephrectomy has become the most widely performed kidney surgery.  

Considering that many patients with a renal mass have co-morbidities including hypertension, diabetes, abnormal cholesterol profile and so on, it is prudent to preserve as much renal function as possible by not removing the unaffected nephrons. 

Robotic partial nephrectomy is an excellent method for treating small renal tumours and some selected larger tumours. As well as safely removing the mass and preserving kidney, the benefits of a minimally invasive approach will mean reduction in pain, faster recovery and earlier return to normal function for the patients.

 

This video shows a left sided RPN by Homi Zargar

 

The wrist articulation and 3D magnified vision allow the surgeon to perform complex surgery in a minimally invasive fashion recapitulating the open technique. During the procedure the blood flow to the kidney is interrupted, the tumour is excised, the kidney is reconstructed and blood flow is re-established (watch a short video here). Typically only 10-15% of the renal parenchyma is removed and the patient is often discharged the subsequent day. Patients can return to normal activities within two weeks from the surgery. 

Available data suggests that compared to pure laparoscopic approach, robotic partial nephrectomy is associated with lower complications and better outcomes.

Dr. Zargar was trained for this procedure at the Cleveland Clinic, which is one of the world’s leading institutions for this technique. As well as the technical expertise Dr. Zargar is an expert in the field of renal preserving surgery with over 50 publications in the peer reviewed journals on this topic. Homi offers robotic partial nephrectomy in public (Royal Melbourne Hospital) and private (Epworth Healthcare) settings.