Robotic Partial Nephrectomy
Robotic Kidney-Preserving Surgery
Robotic partial nephrectomy is a minimally invasive operation used to remove a tumour from the kidney while preserving as much healthy kidney tissue as possible.
Rather than removing the entire kidney, the surgeon removes the tumour together with an appropriate margin of surrounding tissue and reconstructs the remaining kidney. For suitable patients, this provides a way of treating a kidney tumour while retaining functioning kidney tissue.
Mr Neil Oakley has extensive experience in minimally invasive kidney surgery and performs robotic partial nephrectomy for appropriate kidney tumours. Patients from Sheffield and South Yorkshire can have their consultation and assessment locally in Sheffield, with robotic surgery undertaken in Manchester.
What Is a Partial Nephrectomy?
A partial nephrectomy is an operation in which only the part of the kidney containing the tumour is removed.
The aim is to remove the tumour completely while preserving the remainder of the kidney. For this reason, partial nephrectomy is also sometimes referred to as kidney-preserving or nephron-sparing surgery.
This differs from a radical nephrectomy, where the whole affected kidney is removed.
Whether partial nephrectomy is possible depends on the individual tumour and the patient's circumstances. A detailed assessment of the kidney and tumour on imaging is therefore an important part of planning surgery.
Find out more about Kidney Cancer
Why Preserve the Kidney?
The kidneys filter waste products and excess fluid from the blood and perform a number of other important functions within the body.
Although many people can live normally with one healthy kidney, preserving functioning kidney tissue can be beneficial where this can be achieved safely while effectively treating the tumour.
This may be particularly important for patients who already have reduced kidney function, medical conditions that could affect kidney health in the future, or abnormalities affecting the other kidney.
The objective of partial nephrectomy is therefore to achieve appropriate treatment of the kidney tumour while retaining as much healthy functioning kidney as reasonably possible.
Who May Be Suitable for Partial Nephrectomy?
Partial nephrectomy is commonly considered for small or localised kidney tumours where the cancer can be removed while leaving a sufficient amount of healthy kidney behind.
However, tumour size alone does not determine whether kidney-preserving surgery is possible.
Important considerations include:
- The size of the kidney tumour
- Its position within the kidney
- How deeply the tumour extends into the kidney
- Its relationship to the kidney's major blood vessels
- Its relationship to the urinary drainage system
- The amount of healthy kidney that can potentially be preserved
- Kidney function before surgery
- The condition and function of the opposite kidney
- The patient's general health and other medical conditions
Some relatively small tumours can be technically complex because of their position, while other larger tumours may still be suitable for partial nephrectomy in selected circumstances.
Careful review of CT or MRI imaging is therefore particularly important when deciding whether partial nephrectomy is appropriate.
How Is Robotic Partial Nephrectomy Performed?
Robotic partial nephrectomy is performed under general anaesthetic using a minimally invasive or ‘keyhole’ surgical approach.
A camera and robotic surgical instruments are introduced through a number of small incisions in the abdomen. The surgeon operates from a console and remains in complete control of the instruments throughout the procedure.
The kidney and tumour are carefully identified and the surgeon assesses the relationship between the tumour, healthy kidney tissue, blood vessels and urinary drainage system.
During the operation, the blood supply to part or all of the kidney may need to be temporarily controlled while the tumour is removed.
The tumour is then carefully excised with an appropriate margin of tissue. Any opened blood vessels or part of the kidney's urine-collecting system are repaired as necessary, and the remaining kidney is reconstructed.
The removed tumour is subsequently sent for detailed examination by a specialist pathologist.
Why Is Robotic Surgery Used for Partial Nephrectomy?
Partial nephrectomy requires precise surgery because the objective is not simply to remove a tumour, but also to preserve and reconstruct the remaining kidney.
The da Vinci robotic surgical system provides the surgeon with a magnified three-dimensional view of the operating area and articulated instruments that allow highly controlled movements within the body.
This can assist with important stages of the operation, including:
- Identifying the tumour and surrounding anatomy
- Dissecting around the kidney and its blood vessels
- Precisely removing the kidney tumour
- Controlling bleeding
- Repairing the kidney's drainage system where required
- Reconstructing the remaining kidney
The robotic system does not perform the operation independently. The surgeon controls the camera and instruments and makes all surgical decisions throughout the procedure.
Robotic Partial Nephrectomy or Full Kidney Removal?
Where partial nephrectomy can provide appropriate treatment of the tumour, preserving healthy kidney tissue may be preferable to removing the entire kidney.
However, partial nephrectomy is not suitable for every kidney tumour.
If a tumour is particularly large, centrally located, involves important structures within the kidney or cannot safely be removed while leaving an adequately functioning kidney, removal of the whole kidney may provide the more appropriate treatment.
The decision between partial nephrectomy and complete nephrectomy therefore needs to balance effective treatment of the tumour with the benefits and potential risks of attempting to preserve the kidney.
Mr Oakley can review the patient's imaging and discuss whether kidney-preserving surgery appears technically and clinically appropriate.
Find out more about Robotic Nephrectomy
What Are the Potential Benefits of Robotic Partial Nephrectomy?
For appropriately selected patients, partial nephrectomy offers the important advantage of retaining healthy functioning kidney tissue while removing the tumour.
Using a robotic minimally invasive approach also avoids the larger incision associated with traditional open kidney surgery.
Potential advantages of a robotic approach can include:
- Preservation of healthy kidney tissue
- Smaller surgical incisions compared with open surgery
- Reduced blood loss compared with traditional open surgery in many patients
- Less post-operative discomfort for many patients
- Earlier mobilisation following surgery
- Detailed visualisation during tumour removal and kidney reconstruction
Individual outcomes vary, and the choice of surgical technique should be based on the characteristics of the tumour and the patient's individual circumstances rather than the technology alone.
What Are the Risks of Partial Nephrectomy?
Robotic partial nephrectomy is a major surgical procedure and has potential risks and complications. These will be discussed as part of the consent process before surgery.
Potential risks can include:
- Bleeding during or after surgery
- Infection
- Blood clots
- Urine leakage from the reconstructed kidney
- Reduced function of the operated kidney
- Injury to surrounding organs or structures
- The need for further procedures or treatment
- The possibility that removal of the whole kidney may become necessary
There are also risks associated with general anaesthesia and major abdominal surgery.
Your individual risk will depend on factors including the complexity and position of the tumour, kidney function, general health and previous surgery.
Could the Whole Kidney Still Need to Be Removed?
The intention of partial nephrectomy is to preserve the kidney, but there are circumstances in which complete removal of the kidney may become necessary.
This could occur if the tumour proves more difficult to safely separate from the kidney than anticipated, if there is significant bleeding that cannot otherwise be controlled, or if reconstruction of a safely functioning kidney is not possible.
The likelihood of this occurring depends on the complexity of the individual tumour and should be discussed before surgery.
Recovery After Robotic Partial Nephrectomy
Recovery varies between patients, but mobilisation is encouraged following surgery and activity can gradually be increased as healing progresses.
Some discomfort around the abdominal incisions is expected during the early recovery period, together with tiredness following major surgery.
Patients will be given individual advice about:
- Looking after the surgical wounds
- Pain relief
- Walking and general activity
- Driving
- Heavy lifting and exercise
- Returning to work
The timing of returning to normal activities depends on the individual patient's recovery and the physical demands of their work and lifestyle.
What Happens to the Kidney Tumour After Surgery?
The tissue removed during partial nephrectomy is sent to a specialist pathologist for examination.
The pathology report can confirm the nature of the tumour and provide important information about its type and characteristics.
The surgical margin is also examined to assess whether the tumour has been completely removed at the edge of the excised tissue.
These results help determine the appropriate follow-up after surgery.
Follow-Up After Partial Nephrectomy
Follow-up following kidney cancer surgery depends on the final pathology results and the characteristics of the tumour.
This may include:
- Clinical review
- Blood tests to monitor kidney function
- Blood pressure monitoring where appropriate
- Follow-up scans
- Longer-term surveillance for kidney cancer
The frequency and duration of follow-up will depend on the individual patient's results and circumstances.
Robotic Partial Nephrectomy for Sheffield Patients
Patients from Sheffield, South Yorkshire and surrounding areas who have been diagnosed with a kidney tumour can arrange a private consultation with Mr Oakley in Sheffield.
A detailed review of your CT or MRI scans can help determine whether surgery is required and whether the tumour may be suitable for a kidney-preserving robotic partial nephrectomy.
If you decide to proceed with robotic surgery, appropriate consultation and pre-operative assessment can take place locally in Sheffield, with robotic partial nephrectomy performed by Mr Oakley in Manchester using the da Vinci robotic surgical system.
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Robotic Surgery for Sheffield Patients
Could Your Kidney Tumour Be Treated While Preserving the Kidney?
If you have been diagnosed with a kidney tumour and would like to discuss whether robotic partial nephrectomy may be an appropriate treatment option, you can arrange a private consultation with Mr Neil Oakley in Sheffield.