Robot assisted Laparoscopic Partial Nephrectomy

The standard treatment for patients with suspected kidney cancer has been to remove the complete kidney. This is known as radical nephrectomy and is almost always done keyhole at the Staffordshire Urology Clinic. However, there is a risk of future kidney failure if one kidney is removed in this way, especially if there is already evidence that the kidney to be preserved is not working perfectly. For this reason it may be suggested that some tumours could be better by only removing the part of the kidney containing the tumour. This has the advantage of preserving as much functioning kidney tissue as possible, but is a much more demanding surgical procedure, with higher risks of complications (in particular there are increased risks of bleeding, urine leak and damage to the kidney; all which may lead to the kidney needing to be removed either at the time of surgery or at a later date). There is also the risk of cancer returning in the remaining, preserved part of the kidney, which may need further treatment. Despite the drawbacks, partial nephrectomy is widely accepted as a better treatment for many kidney tumours smaller than 4cms in size, and is increasingly seen as better for some tumours larger than 4cms in size.

Despite this being a very demanding procedure even through a large cut and open operation, our surgeons often successfully perform this partial kidney removal laparoscopically (keyhole), which is even more complex. Performing this procedure keyhole has been shown to be equally as effective at cancer cure compared to an open operation, but allows a much quicker recovery. It can be performed purely using keyhole instruments (top video)

…….or with the assistance of inserting 1 hand through a small hole (called Hand Assisted Laparoscopic nephrectomy, also known as HAL Nephrectomy) , which doubles as the hole required to remove the tumour (lower video). In our opinion this latter technique has some advantages over the pure keyhole method, although it does require a slightly larger hole and therefore leaves a slightly larger surgical scar.

More recently we have developed the use of Robot assisted Partial Nephrectomy, which is now our favoured approach to this complex surgery.

Partial removal of the kidney can also be used for treatment of a non-functioning or painful part of the kidney in selected cases.