Robotic Partial Nephrectomy

Before your surgery, you will be given anesthesia to put you to sleep. During surgery, the surgeon sits at a computer console in the operating room. They use hand controls at the console to operate the da Vinci Surgical System. The robotic surgery tools copy the hand motions the surgeon makes at the console.

Once the robotic surgical system is in place, the surgeon will use it to make three or four incisions, or cuts, in the skin. Each one is about an inch long or shorter. The surgical instruments are then inserted into the incisions. A camera attached to the instruments provides the surgeon with a real-time 3D image of the inside of the body. This helps them perform the partial nephrectomy with precision. After a portion of the kidney is removed, the incisions are closed and you are moved to a recovery area. The procedure generally takes three or more hours to complete.

You can expect a one-night hospital stay after a robotic partial nephrectomy. It’s common to have discomfort, mild pain or numbness near your incisions during the early stages of recovery. In most cases, people can return to work two to three weeks after surgery. However, patients will likely have activity restrictions for four to six weeks after surgery.

Depending on your unique needs, your follow-up appointments after surgery may be scheduled as in-person or virtual visits.

Robotic partial nephrectomy surgery requires expert skill and a specialized robotic surgical system. Find a location near you.

A partial nephrectomy is most often used as a treatment for kidney cancer, including:

• Renal cell carcinoma

• Renal sarcoma

• Transitional cell carcinoma

• Wilms tumor, or nephroblastoma

When cancer is detected early, a partial nephrectomy may be able to remove the entire cancerous tumor while preserving as much kidney function as possible. Imaging tests, such as MRI or CT scans, can often detect kidney tumors. People who have a robotic or minimally invasive partial nephrectomy to treat kidney cancer have a 10-year survival rate of nearly 90%.

Partial nephrectomies may also be used to treat other kidney-related conditions, including:

• Congenital issues, or medical issues that are present from birth

• Infection

• Injury

• Issues with blood supply to the kidneys

• Kidney damage

There are three main types of nephrectomy:

• Partial, where a part of the kidney is removed

• Simple, which involves removing a whole kidney

• Radical, also known as total nephrectomy, in which the kidney, adrenal gland and fat and tissue around the kidney are all typically removed

The decision to do a partial instead of a simple or total nephrectomy is based on several factors, including:

• Body weight

• How well your kidneys work before surgery

• Kidney tumor size

• Other medical conditions

• Stage of the cancer being treated

• Your surgical history

People can live well with only one healthy kidney. Still, preserving as much of a kidney as possible during a partial nephrectomy can benefit overall health.

However, a total nephrectomy may be a better option or the only option in some cases, including when:

• A partial nephrectomy will not successfully remove all of the cancer.

• The kidney is not functioning before surgery.

Partial nephrectomies may be done through traditional open surgery, standard laparoscopic surgery or robotic-assisted surgery.

An open partial nephrectomy is likely what you picture when you think about kidney surgery. This type of surgery requires a large incision to give the surgeon direct access to the inside of the body. Open surgery often requires a longer recovery time, may cause more pain and has a higher risk of infection.

Unlike open surgeries, minimally invasive approaches only require small keyhole incisions. The surgeon threads long, thin instruments into the incisions to perform the procedure. Standard laparoscopic surgery and robotic-assisted surgery are minimally invasive surgeries.

There are several benefits to a minimally invasive approach to partial nephrectomy, including:

• Decreased pain

• Less blood loss

• Lower risk of infection

• Quicker recovery

• Shorter hospital stay

• Smaller scars

A robotic approach offers additional benefits, including:

• Better visualization for the surgeon

• Fewer postoperative complications than open or standard laparoscopic surgery

• Improved dexterity with surgical instruments

• Increased precision during surgery

• Lower risk of needing to change course and perform an open surgery

• Tremor filtering that prevents small, unintended movements during surgery

Although a robotic-assisted partial nephrectomy uses smaller incisions and typically has a shorter recovery time than an open surgery, it is still a major surgery. Robotic partial nephrectomies are safe and are the preferred surgical approach in most cases. The likelihood of having a complication is low. Still, just like other surgeries, there are potential risks.

Bleeding during surgery or the first two to three weeks after surgery is the most common complication of a robotic partial nephrectomy. Patients who experience bleeding may need a blood transfusion.

Other possible complications include:

• Acute kidney injury

• Allergic reaction to anesthesia or other medications

• Death

• Infection

• Kidney failure