Kidney Surgery

Learn about kidney cancer surgery and understand your options

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It can be hard to learn you have kidney cancer, especially if you did not have any signs or symptoms. Even if you had signs of kidney cancer, such as blood in your urine, fatigue, or weight loss, these are often caused by other, benign, diseases¹ and you were probably not expecting this diagnosis. 

A diagnosis is the first step on your path to address your cancer. You might be surprised to find out how many other Americans are walking with you on the journey through kidney cancer. In 2019, the American Cancer Society estimates more than 73,000 people in this country will receive a kidney cancer diagnosis.² So, you are not alone.

Understanding your options

After diagnosis, doctors are likely to do more tests to learn as much as they can about the cancer and your overall health before deciding on the next steps. There are many options available for care today, including chemotherapy, immunotherapy, systemic targeted therapies, local therapies that target the tumor directly, and radiation therapy. 

Your doctor may recommend a partial or radical nephrectomy, which is surgery to remove some (partial) or all (radical) of the affected kidney or kidneys. In radical nephrectomies for kidney cancer, surgeons also remove the adrenal gland that sits above your kidney, surrounding fat, and nearby lymph nodes, which will be tested to see if the cancer has spread. In a partial nephrectomy, also called “kidney-sparing” surgery, the surgeon removes the tumor while leaving as much healthy kidney tissue as possible.

Surgeons can perform partial and radical nephrectomies through open surgery or a minimally invasive approach. Traditional open surgery requires a long incision in your side, abdomen, or back and may also require doctors to take out your lowest rib. During open surgery, the surgeon looks directly at the surgical area and removes part or all of the kidney using hand-held tools. 

There are two minimally invasive approaches to radical and partial nephrectomies: laparoscopic surgery and robotic-assisted surgery, possibly with da Vinci technology. Surgeons perform minimally invasive laparoscopic or robotic-assisted surgeries through a few small incisions. To perform a laparoscopic nephrectomy, surgeons use special long-handled tools while viewing magnified images from the laparoscope (camera) on a video screen.

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How da Vinci works

Surgeons using da Vinci technology may be able to perform kidney surgery through a few small incisions (cuts). During surgery, your surgeon sits at a console next to you and operates using tiny instruments. The da Vinci system translates every hand movement your surgeon makes in real time to bend and rotate the instruments with precision.

A camera provides a high-definition, 3D magnified view inside your body. Your surgeon may use Firefly® fluorescence imaging, which offers visualization beyond the human eye by activating injected dye to light up and clearly show the kidney structures and blood vessels. Firefly is commonly used to assess the blood flow to the kidney, which may help your surgeon during the procedure in a partial nephrectomy.

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It’s important to remember that Intuitive does not provide medical advice. After discussing all options with your doctor, only you and your doctor can determine whether surgery with da Vinci is appropriate for your situation. You should always ask your surgeon about his or her training, experience, and patient outcomes.

More about da Vinci

Why surgery with da Vinci?

• A review of published studies suggest that potential benefits after a partial nephrectomy with da Vinci technology are:
• Patients may experience fewer overall complications than patients who had open^3,4 or laparoscopic^5,6 surgery.
• Patients may stay in the hospital for a shorter amount of time than patients who had open surgery^3,4,7,8,9 or shorter,^3,9,10,11 or similar,^{4,12,13,14,15} time than patients who had laparoscopic surgery. 
• Patients may experience less pain than patients who had open surgery.^4,16,17 
• Surgeons may be less likely,^10,15 or with similar likelihood,^4,12,18 to switch to an open procedure when performing surgery with da Vinci, compared to when performing laparoscopic surgery.

All surgery involves risk. You can read more about associated risks of partial nephrectomy here.

Disclosures and Important Safety Information

Questions you can ask your doctor

• What medical and surgical options are available for me?
• Which is best for my situation? 
• If I decide to have surgery, am I a candidate for a partial nephrectomy? 
• What are the differences between open, laparoscopic, and robotic-assisted surgery?
• What am I likely to experience after surgery?
• Can you tell me about your training, experience, and patient outcomes with da Vinci?

More about urologic surgery with da Vinci 

Robotic-assisted surgery with da Vinci technology is used in many different types of procedures by urology surgeons.

About the specialty

 

^{1. Kidney Cancer Signs and Symptoms. American Cancer Society. Web. 18 January 2019} 

^{2. Key Statistics About Kidney Cancer. American Cancer Society. Web. 17 January 2019}

^{3. Xia, L., X. Wang, T. Xu and T. J. Guzzo (2016). "Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy versus Open Partial Nephrectomy."J Endourol.}

^{4. Aboumarzouk, O. M. S., R. J.; Eyraud, R.; Haber, G. P.; Chlosta, P. L.; Somani, B. K.; Kaouk, J. H. (2012). Robotic Versus Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis. European Urology.}

^{5. Khalifeh A, Autorino R, Hillyer S et al. Comparative Outcomes and Assessment of Trifecta in 500 Robotic and Laparoscopic Partial Nephrectomy Cases: A Single Surgeon Experience. The Journal of Urology. 2013;189(4):1236-1242. doi:10.1016/j.juro.2012.10.021.}

^{6. Kim J, Park Y, Kim Y et al. Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison. World J Urol. 2015;33(10):1579-1584. doi:10.1007/s00345-015-1488-5.}

^{7. Zhang, X., et al. (2014). Robot-assisted versus laparoscopic partial nephrectomy for localized renal tumors: a meta-analysis. International Journal of Clinical and Experimental Medicine. 7: 4770-4779.}

^{8. Hadjipavlou, M., F. Khan, S. Fowler, A. Joyce, F. X. Keeley and S. Sriprasad (2016). "Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit." BJU Int 117(1): 62-71.}

^{9. Wu, Z., et al. (2014). Robotic versus Open Partial Nephrectomy: A Systematic Review and Meta-Analysis. PLoS ONE. 9: e94878.}

^{10. Froghi, S., et al. (2013). Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU International. 112: E322-333.}

^{11. Leow, J. J., N. H. Heah, S. L. Chang, Y. L. Chong and K. S. Png (2016). "Outcomes of Robotic versus Laparoscopic Partial Nephrectomy: an Updated Meta-Analysis of 4,919 Patients."J Urol.}

^{12. Choi, J. E., et al. (2015). Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. European Urology. 67: 891-901.}

^{13. Zhang, X., et al. (2013). Comparison of peri-operative outcomes of robot-assisted vs laparoscopic partial nephrectomy: a meta-analysis. BJU International}

^{14. Kates, M., M. W. Ball, H. D. Patel, M. A. Gorin, P. M. Pierorazio and M. E. Allaf (2015). "The financial impact of robotic technology for partial and radical nephrectomy."J Endourol 29(3): 317-322.}

^{15. Lee S, Oh J, Hong S, Lee S, Byun S. Open Versus Robot-Assisted Partial Nephrectomy: Effect on Clinical Outcome. Journal of Endourology. 2011;25(7):1181-1185. doi:10.1089/end.2010.0670.}

^{16. Han K, Song G, You D et al. Comparison of Hand-Assisted Laparoscopic Versus Robot-Assisted Laparoscopic Versus Open Partial Nephrectomy in Patients with T1 Renal Masses. Journal of Endourology. 2014:150127063131006. doi:10.1089/end.2014.0517.}

^{17. Zargar H, Allaf M, Bhayani S et al. Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU International. 2015;116(3):407-414. doi:10.1111/bju.12933.}

^{18. Mir, S. A., et al. (2011). Cost comparison of robotic, laparoscopic, and open partial nephrectomy. Journal of Endourology. 25: 447-453.}

Disclosures and Important Safety Information

Surgical Risks

Risks associated with nephrectomy (kidney removal) including partial nephrectomy (removing part of the kidney) include poor kidney function often due to limited blood flow, leaking of urine, cut or tear in the spleen, pancreas or liver, bowel injury, trapped air between the chest wall and lung, injury to diaphragm (muscle separating the chest from the abdomen), urinary fistula (abnormal bond of an organ, intestine or vessel to another part of the body), abnormal pooling of urine, limited or cut off blood supply to kidney, abnormal pooling of lymph fluid.

Important Safety Information

Patients should talk to their doctor to decide if da Vinci® surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options and associated risks in order to make an informed decision. 

Serious complications may occur in any surgery, including da Vinci surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety.

Individuals' outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.

Da Vinci Xi® System Precaution Statement

The demonstration of safety and effectiveness for the specific procedure(s) discussed in this material was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease/condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.

Medical Advice and Locating a Doctor

Patients should talk to their doctor to decide if da Vinci surgery is right for them. Other options may be available and appropriate. Only a doctor can determine whether da Vinci surgery is appropriate for a patient’s situation. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Surgeons experienced with the da Vinci system can be found using the Surgeon Locator. Intuitive Surgical provides surgeons training on the use of the da Vinci system but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.

Published Evidence

In order to provide benefit and risk information, Intuitive Surgical reviews the highest available level of evidence on procedures named above. Intuitive Surgical strives to provide a complete, fair and balanced view of the clinical literature. However, our materials should not be seen as a substitute for a comprehensive literature review for inclusion of all potential outcomes. We encourage patients and physicians to review the original publicatons and all available literature in order to make an informed decision. Clinical studies are typically available at pubmed.gov.

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