What are the indications for robotic kidney cancer surgery?
Surgery is usually recommended for suspected or biopsy-proven kidney cancer. The choice between removing part of the kidney or all of it depends on the size and position of the tumour, along with other factors including your underlying health and kidney function:
- Partial nephrectomy — Removal of part of the kidney, typically reserved for small or peripheral tumours, or because of poor kidney function. Partial nephrectomy preserves kidney function, but is associated with a higher complication rate than full (radical) nephrectomy.
- Radical nephrectomy — Removal of the entire kidney, performed for larger or more central tumours. Radical nephrectomy has fewer complications than partial nephrectomy, but is associated with a greater loss of kidney function.
What are the alternatives?
- Active surveillance — Monitoring a small tumour with regular scans.
- Cryoablation — Freezing the tumour with probes under image guidance.
- Radiofrequency ablation — Heating the tumour with probes under image guidance.
- Open surgery — Partial or radical removal through a larger incision.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before, and drink clear fluids only within 2 hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.
What does the procedure involve?
- Performed under general anaesthetic, with antibiotics beforehand.
- Five or six small incisions in the abdomen.
- During partial nephrectomy the part of the kidney containing the tumour is removed with its surrounding fat. The kidney defect is then closed with permanent stitches and a drain placed.
- During radical nephrectomy the whole kidney and its surrounding tissue are removed. One incision is enlarged to extract the specimen and closed with internal dissolvable stitches. A drain is usually not necessary.
- Both operations take two to three hours, typically with a 1-2 night stay.
What are the side-effects?
- Abdominal discomfort, shoulder-tip pain and bloating (almost all patients).
- Pain, bleeding, infection or hernia at port sites (5-10%).
- Finding a benign tumour on pathology analysis (5-10%).
- Bleeding needing transfusion, embolisation or conversion to open surgery (1-5%).
- Injury to nearby organs (spleen, pancreas, liver, bowel) requiring open conversion (1-5%).
- Partial nephrectomy only
- Conversion from partial to radical nephrectomy for bleeding or unfavourable tumour characteristics (1-5%).
- Positive surgical margin requiring close post-op follow-up (5-10%).
- Urine leak, requiring placement of an internal stent, abdominal drain or nephrostomy (kidney drain) (1-2%).
What happens after surgery?
You will be encouraged to get up and about quickly. Discomfort at the incision sites can last several weeks and is typically managed with simple painkillers such as paracetamol. Most people recover within 14-21 days and return to work after four to six weeks.
Your pathology results will be discussed at a multidisciplinary team meeting within 2-3 weeks. You will then be reviewed in clinic to discuss the findings and the need for any follow-up scans, which are required for all patients with treated kidney cancer.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Robotic partial nephrectomy
View the BAUS leaflet
Patient information video
Watch the European Association of Urology animated video:
Robot-assisted Partial Nephrectomy