Hand-Assisted Laparoscopic Partial Nephrectomy


A minimally invasive technique used to remove only the diseased or infected portion of the kidney. Once a solid renal tumor is found on kidney imaging, because of the high risk they represent a kidney cancer, surgical excision is the standard treatment. Small renal tumors can often be treated, without sacrificing the entire kidney, by removing only the tumor and a small part of the kidney. Many studies have proven that this technique, termed partial nephrectomy, has similar cure rates to removing the whole kidney, without losing significant renal function. In the past, these operations were performed through a large and painful flank or upper abdominal incision, with risk of significant bleeding routine. Also, recovery time from such an operation was lengthy and difficult. The da Vinci Robotic Partial Nephrectomy has revolutionized kidney surgery by minimizing bleeding, speeding recovery, and maximizing preservation of renal function.

The procedure

After the patient is asleep, depending on the location and size of the tumor, the surgeon may need to place a plastic tube (ureteral stent) into the kidney prior to removing the tumor. The stent is inserted by using a scope through the bladder and is a short procedure which takes approximately 20 minutes. Irrigating this tube will allow the surgeon to see if there is leakage of urine after the tumor is excised from the kidney. The patient is then placed on his/her side on the operating table, and 4-5 keyhole incisions are made on the skin. Long instruments are inserted into the incisions, and the operation is performed through these keyhole incisions. The surgeon watches the inside of the abdomen on a television monitor. The kidney and tumor are exposed, and the artery and vein feeding the kidney are isolated. A clamp is placed across the kidney artery to prevent bleeding. The tumor is cut from the kidney with a rim of normal tissue. After the tumor is removed from the kidney, blue dye is injected into the stent which was previously inserted. The blue dye will allow the surgeon to see areas that need to be repaired to prevent urine leakage. The tumor defect on the kidney is closed with sutures. The clamp on the artery is then released. After the surgeon makes sure that there is no bleeding, the tumor is placed in a bag and removed from one of the incisions. A renal drain is left for 24-48 hours.

After the procedure

The patient will feel less pain compared to the open partial nephrectomy. This is, in part, due to the small keyhole incisions made; compared to an open partial nephrectomy, where a 7-10” incisional scar is made. Further, no large metal retractors for keeping the incision open are necessary, thus contributing to less pain. Less pain also means faster recovery. The patients are typically given regular diet and are walking around by the first day after surgery. Hospitalization is usually 2 days following surgery, and the patients are back to their normal activities by approximately 4 weeks following surgery.