Robotic Retroperitoneal Partial Nephrectomy
What exactly is the goal of this surgery?
Partial removal of the kidney for cancer can be done safely and effectively through a trans peritoneal approach (passing instruments through the abdominal cavity), but such approach requires moving the bowel off the surface of the kidney thus possibly increasing the risks of bowel injury and lazy bowel (ileus) after the surgery. Retroperitoneal approach avoids the abdominal cavity entirely and reaches the kidney directly through the back of the patient. It is ideal for tumors on the back surface of the kidney.
Not only would the retroperitoneal approach avoid manipulating the bowel, but it has also been shown in multiple studies that such approach (1) provide us with more direct access to the blood supply of the kidney and make it easier to decrease blood loss during the surgery and (2) allows the confinement of the surgery products (blood and urine) within the retroperitoneum, minimizing their effects on the abdominal contents.
Being done robotically, what are the advantages to the patient?
The da Vinci platform, given its articulating robotic instruments, allow us to keep a minimally invasive approach to treating the cancer through small incisions while having the range of motion required to treat the cancer with this complex surgery without removing the entire kidney.
This is considered an advanced robotic procedure. Did you take additional training to learn how to perform it?
Yes. I have been trained to do this surgery as part of my surgical training to treat kidney cancer at Memorial Sloan-Kettering Cancer Center in New York.