Robotic Kidney Surgery for Kidney Cancer

Malignant kidney tumors are a rare type of tumor (approximately 3% of all annual oncology cases in Austria and about 2% of cancer deaths). Most tumors (at least 60%) are detected at early stages when the tumor is confined within the organ. In most cases, the tumor is discovered incidentally during examinations for other problems or during a urological screening.

In localized stages of kidney cancer, radical removal of the entire kidney (nephrectomy) or tumor resection with organ preservation most often leads to complete recovery. The choice of surgical method depends on the size and location of the tumor in the kidney.

For many years, laparoscopy has been successfully used in the treatment of kidney tumors. The main disadvantage of laparoscopy is the limited mobility of the tools and difficult access to anatomical structures. Robotic technology solves these problems and significantly expands the surgeon’s capabilities and increases the safety of the intervention.

Advantages of robotic technology in kidney surgery include:

• Minimal invasiveness of the intervention, minimal blood loss
• Significant reduction in postoperative pain
• Quick wound healing, good cosmetic and functional results
• Reduced hospital stay

As part of the preparation for surgery, you will need an operation permit from your therapist. Hospitalization takes place the day before the surgery. You will be thoroughly informed about the procedure and possible complications.

The intervention is always performed under general anesthesia.

The surgery is carried out similarly to laparoscopic techniques. Several small incisions (from 5 mm to 12 mm) are made in the abdominal wall to insert robotic instruments and suturing material. The abdominal cavity is filled with gas to create sufficient working space.

The latest generation DaVinci operating system provides the surgeon with a three-dimensional image of the surgical field with tenfold magnification. This allows for precise visualization and careful handling of delicate anatomical structures, such as small vessels or nerves. Manipulations are performed using microsurgical instruments with the highest precision. This allows for manipulation of anatomical structures in hard-to-reach areas of the body, which is virtually impossible with other surgical techniques.

If necessary, a special ultrasound probe is introduced into the abdominal cavity. With its help, the position of the tumor and its boundaries can be precisely determined during the operation, in order to remove the tumor within healthy tissue. In some special cases, the blood supply to the kidney or tumor is monitored using fluorescent contrast agent (ICG).

If the size and location of the tumor allow, nephron-sparing surgery is performed to preserve healthy kidney tissue. For large and difficult-to-reach tumors, complete kidney removal (radical nephrectomy) is required. At the end of the surgery, the specimen is extracted through an enlarged port in the abdominal wall and sent for histological examination.

The surgery lasts from one to several hours, depending on the complexity.

After surgery, all patients initially go to a recovery room, where vital parameters are carefully monitored; transfer to the general ward is usually possible within 4-6 hours. During the first and second postoperative days, the patient is mobilized, and the abdominal drainage is removed. Patients are typically discharged on the fifth postoperative day. Skin staples may be removed starting from the seventh postoperative day (before discharge or in an outpatient setting). The usual hospital stay from admission to discharge is six days.