da Vinci Surgery
 

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

Surgical Options

Thermal Ablation

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

Open Surgery

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 Laparoscopy

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.

PN 1002151 Rev A 04/2013
  1. Kidney Cancer Association; Surgical Treatment; www.kidneycancer.org; URL: http://www.kidneycancer.org/knowledge/learn/surgical-treatment
  2. 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
  3. 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
  4. 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 and other minimally invasive procedures.  Serious complications may occur in any surgery, up to and including death. Examples of serious or life-threatening complications which may require hospitalization include injury to tissues or organs, bleeding, infection or 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. Risks of surgery also include potential for equipment failure and human error. Risks specific to minimally invasive surgery may include: A long operation and time under anesthesia, conversion to another technique or the need for additional or larger incisions.  If your surgeon needs to convert the procedure, it could mean a long operative time with additional time under anesthesia and increased complications. Temporary pain or discomfort may result from pneumoperitoneum, the presence of air or gas in the abdominal cavity used by surgeons in minimally invasive surgery. Research suggests that there could be an increased risk of incision-site hernia with single-incision surgery. Results, including cosmetic results, may vary.  Patients who bleed easily, who have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci® Surgery. For more complete information on surgical risks, safety, and indications for use, please refer to http://www.davincisurgery.com/safety/. Patients should talk to their doctors about their surgical experience and to decide if da Vinci Surgery is right for them. Other options may be available. Intuitive Surgical reviews clinical literature from the highest level of evidence available to provide benefit and risk information about use of the da Vinci Surgical System in specific representative procedures. We encourage patients and physicians to review all available information on surgical options and treatment in order to make an informed decision. Clinical studies are available through the National Library of Medicine at www.ncbi.nlm.nih.gov/pubmed.

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