Robotic Surgery for Benign and Cancerous Kidney Tumors
Radical nephrectomy can be performed through a robotic approach. This is a minimally invasive approach to what was historically an open procedure performed through a large muscle-cutting flank incision (see nephrectomy incision comparison). Patients who undergo robotic radical nephrectomy can expect significantly reduced pain and faster recovery as compared to open surgery. Most patients are able to leave the hospital the day after surgery.
How a Robotic Radical Nephrectomy is Performed
The surgery begins first by inflating the abdomen with carbon dioxide so that the 3-D high definition robotic camera can be used to visualize the internal structures of the abdomen through a 1cm incision. The robotic working instruments are then inserted through the skin into the abdomen by placing special ports called trochars. Trochars are 8 mm instruments that have a valve mechanism to prevent the pressurized gas from escaping while permitting the passage of small instruments required to perform the surgery. At this point the robot is then “docked” whereby the robotic patient cart (see robot docking image) is brought to the patient’s bedside and the arms of the robot are attached to the camera port and robotic trochars. The “robot” is motionless without the surgeon. Once docked, the surgeon takes full control of the camera and all robotic arms through a sophisticated surgeon console that is in the operating room (see surgeon console image). Inside the surgeon console the surgeon has the advantage of magnified 3-dimensional high-definition vision of the operative field (see inside console view). A bedside assistant is required to provide retraction, suction, and the passage of necessary instruments and sutures into the abdomen.
Due to the location of the kidney in the retroperitoneum, the first steps involve exposure of the kidney by carefully reflecting the left or right colon. Once the major blood vessels to the kidney are identified and isolated (the renal artery and vein), they are ligated and divided, typically with a surgical stapling device. At this point the kidney is no longer functional. The remaining attachments of the kidney are freed and the ureter is divided. In order to minimize pain and maximize the cosmetic result of the surgery the specimen is typically removed through an incision below the waist line (a Pfannenstiel incision). This incision does not require cutting of any of the abdominal wall musculature and therefore is associated with significantly less pain.