Treatments and Surgical Options
Surgery is considered the main treatment for most kidney cancers.1 A variety of surgical options are available depending on the type, size of tumor, extent of disease, and the patient's overall physical condition. Your doctor will discuss all surgical and non-surgical options that are appropriate for your condition.
Radical Nephrectomy versus Partial Nephrectomy (Kidney-sparing)
Radical nephrectomy is the surgical removal of the entire kidney. Depending on your disease state and tumor location, you may not have to lose your entire kidney to surgery. A surgical technique called partial nephrectomy aims to remove only the diseased part of your kidney and spare the healthy, functioning kidney tissue.
Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease (CKD) after surgery than patients who received a kidney-sparing partial nephrectomy.2 In fact, the American Urological Association states that partial nephrectomy is considered the treatment of choice for most T1 renal masses (small to medium-sized kidney tumors).3
An alternative therapy for kidney cancer is to use extreme temperatures. Cryotherapy freezes the tissue to kill cancer cells and radiofrequency uses heat to destroy cancer cells. Both methods use several tiny probes that are inserted into the kidney tumor either through an open or laparoscopic surgical technique. Thermal ablation therapy does not take the cancerous tissue out of the body, but rather uses probes to deliver extreme temperatures to tumors in the hopes that all cancerous tissue is destroyed.
An important note, studies show that patients treated with ablation (cryoablation or radiofrequency) had a significantly higher rate of recurrence - meaning the cancer returned - as compared to partial nephrectomy patients.4
Kidney surgery is often performed using traditional open surgery. Open surgery, also called laparotomy, is any surgical procedure in which a large cut/incision is made to reach your organs. The incision must be large enough for your surgeon to fit his or her hands and surgical instruments inside your body. While open surgery allows your surgeon to see and touch your organs, it is invasive and can be traumatic on your body due to the large incision.
Minimally Invasive Surgery
There are minimally invasive surgical options for patients facing kidney surgery. Minimally invasive surgery is generally associated with a shorter hospital stay and recovery, as well as other potential benefits from doctors using smaller incisions.
Traditional laparoscopic surgery is minimally invasive – meaning surgeons operate through a few small incisions. Long, thin surgical instruments and a tiny camera are inserted through the incisions to reach your kidney. The camera takes images inside the body and those images are sent to a video monitor in the operating room. The monitor guides surgeons as they operate.
da Vinci Partial Nephrectomy
With the da Vinci Surgical System, surgeons make just a few small incisions - similar to traditional laparoscopy. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your surgeon to operate with enhanced vision, precision, dexterity and control.
State-of-the-art da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. da Vinci – taking surgery beyond the limits of the human hand.
- Learn more: da Vinci Partial Nephrectomy
- Kidney Cancer Association; Surgical Treatment; www.kidneycancer.org; URL: http://www.kidneycancer.org/knowledge/learn/surgical-treatment
- Huang WC, Elkin EB, Levey AS, Jang TL, Russo P; Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors-Is there a Difference in Mortality and Cardiovascular Outcomes; The Journal of Urology, Vol. 181, 55-62, January 2009
- American Urological Association; Guideline for Management of the Clinical Stage I Renal Mass; 2009; URL: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/renalmass09.pdf
- Kunkle D, Egleston B, Uzzo R; Excise, Ablate or Observe: The Small Renal Mass Dilemma - A Meta Analysis and Review. The Journal of Urology, Vol. 179, 1227-1234, April 2008
All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to other surgical techniques; the need for additional or larger incision sites; a longer operation or longer time under anesthesia than your surgeon originally predicts. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php
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