Minimally Invasive Treatment of Kidney (Renal) Cancer

Laparoscopic radical nephrectomy

Laparoscopic radical nephrectomy involves removal of the kidney, the adjacent adrenal gland, and a segment of the ureter with adjacent lymph nodes using sophisticated instruments inserted through 3-4 small skin incisions rather than the large incision of traditional surgery. The surgeon performs the surgery while watching the magnified images of the operative field on a monitor with the help of a telescope inserted into the patient’s abdomen. After the kidney is completely separated from all its surrounding attachments, it is removed through a small 3 inch incision. A modification of this technique known as hand-assisted laparoscopic surgery (HALS) involves the insertion of the surgeon’s hand into the patient’s abdomen through a 3 inch incision while the other hand manipulates the laparoscopic instruments. The incision used to insert the hand is used at the end of the procedure to extract the specimen. The benefits to the patient of undergoing radical nephrectomy using these minimally invasive laparoscopic techniques are decreased postoperative pain, faster recovery, smaller scar and decreased blood loss. Radical nephrectomy is indicated when the renal mass is large and is situated in a part of the kidney that prevents removal of the tumor without damaging the kidney beyond salvage. Examples include tumors that invade major blood vessels leading into or out of the kidney, or tumors that invade into the collecting system that might make reconstruction of the kidney impossible after the cancer is removed.

Laparoscopic partial nephrectomy

Laparoscopic partial nephrectomy is a minimally invasive technique of removing only the kidney tumor while leaving the rest of the kidney intact inside the patient (Kidney Sparing Surgery). It is usually indicated for tumors less than 4 cms but can be performed for larger tumors in certain circumstances such as patients with only one functioning kidney, or in patients who are at risk for kidney failure (especially patients with hypertension or diabetes). The surgery is performed by inserting specialized long instruments through 3-4 small skin incisions as compared to the large incision of traditional surgery. The surgeon performs the surgery while watching the magnified images of the operative field on a monitor with the help of a telescope inserted into the patient’s abdomen. The tumor is identified and marked using a special ultrasound probe. The tumor is then excised with a small rim of surrounding normal kidney tissue and sent for pathology examination. The remaining portion of the normal kidney is then repaired laparoscopically.

Laparoscopic renal cryoablation

Laparoscopic renal cryoablation is a method of destroying (’freezing’) the tumor within the kidney while leaving the rest of the kidney intact (Kidney Sparing Surgery). It is usually indicated for kidney tumors less than 4 cms in size. Due to the limited availability of long term data, this technique is usually performed in patients who cannot tolerate more invasive surgery (such as laparoscopic partial nephrectomy, laparoscopic radical nephrectomy) due to poor general health or in elderly patients. The surgery is performed by inserting specialized long instruments through 3-4 small skin incisions as compared to the large incision of traditional surgery. The surgeon performs the surgery while watching the magnified images of the operative field on a monitor with the help of a telescope inserted into the patient’s abdomen. The tumor is identified and marked using a special ultrasound probe inserted through one of the small skin incisions. Special long needles are then inserted under visual and ultrasound guidance into the kidney tumor. The tumor is then frozen (cryoablated) by passing Argon gas through these needles which decreases the temperature to -40 degrees Celsius and destroys the tumor cells. The tumor is then thawed by passing Helium gas thrugh these needles. The freeze/thaw process is repeated two times to complete the destruction of the tumor cells after which the needles are removed. The dead tumor tissue which is left inside the patient does not grow any further and usually shrinks in size slowly over time. The patient requires regular follow up with CT scans or MRI studies to confirm the success of the procedure. This entire surgery is performed laparoscopically without the need for a large incision.

Laparoscopic radical nephroureterectomy

Laparoscopic Radical Nephroureterectomy includes removal of the kidney as well as the entire ureter (tube connecting the kidney to the urinary bladder). This procedure is indicated in certain tumors of the kidney which arise from the inner lining of the kidney (Transitional Cell Carcinoma). The initial part of the surgery is similar to laparoscopic radical nephrectomy in which the kidney, the adjacent adrenal gland, and the upper portion of the ureter with adjacent lymph nodes is removed using specialized instruments inserted through 3-4 small skin incisions as compared to the large incision of traditional surgery. The surgeon performs the surgery while watching the magnified images of the operative field on a monitor with the help of a telescope inserted into the patient’s abdomen. A modification of this technique known as hand-assisted laparoscopic surgery (HALS) involves the insertion of the surgeon’s hand into the patient’s abdomen through a 4-5 cm incision while the other hand controls the laparoscopic instruments. The lower portion of the ureter is then removed with a cuff of bladder wall, which is then repaired.

Robotic renal surgery

Robot-assisted laparoscopic surgery is laparoscopic surgery using the da Vinci robot. From a nearby console, the surgeon controls the movements of the binocular camera and three instruments which are inserted into the abdominal cavity through laparoscopic trocars. The dexterity of these special instruments and 3-dimensional magnified vision provided by the dual-camera laparoscope and binocular view at the console allows for increased precision during laparoscopic surgery.

This technology is now being used to perform minimally invasive surgery for kidney tumors. The increased dexterity of the instruments is a potential benefit while performing complex kidney tumor surgery such as laparoscopic partial nephrectomy which requires reconstruction of the remaining portion of the kidney after the tumor has been removed.

The University of Cincinnati Urology Division is one of the leading urology programs, not just in Cincinnati, but in the U.S. UC Urology provides quality health care using the most advanced technology and state-of-the-art diagnostic treatments. Many of our urologists are recognized in multiple national and local "Best Doctors" and "Top Doctors" listings. We provide minimally invasive surgical treatments which include laparoscopic, robot-assisted laparoscopic and endourologic procedures as well as comprehensive care for all urologic conditions.