Robotic partial nephrectomy surgery consists of removing a part of a kidney, to treat cancer by preserving as much healthy kidney tissue as possible.
Who needs a robotic partial nephrectomy?
-Patient with small kidney tumor (<4 cm in size).
-Patient with risk of kidney failure and the need of dialysis when the procedure consists of removing all the kidney.
Kidney Tumors between 4 and 7 centimeters can be treated with robotic partial nephrectomy if they are located in certain areas.
Some Tips before the surgery:
-Stop taking blood thinners 5 to 7 days before the surgery.
-Anti-inflammatory medications and certain vitamin supplements can cause increased bleeding, so the surgeon and the anesthetist should be informed about all your medications.
-It’s very necessary to stop smoking few days before the procedure.
-Not eat or drink anything after midnight the night before your surgery, to prevent anesthesia complications.
During a robotic partial nephrectomy:
This procedure is performed under general anesthesia, by making small cuts in the abdomen; so the robotic surgical equipment and camera can be inserted.
Carbon dioxide gas is used to inflate the abdominal cavity to leave space for the manipulation of the surgical equipment and camera to access the cancerous tissues.
While the surgeon is performing the procedure by manipulating the robot, the blood flow to the cancerous kidney is totally stopped; so the kidney can be dissected and the cancerous portion is detached from the tissue. The tumor is totally removed from the body and the surgeon sews the remaining section of the healthy kidney.
After a robotic partial nephrectomy:
– Take analgesics to reduce post-operative pain.
-Walk after a few days of surgery to promote good blood circulation and prevent pneumonia.
-Start with a liquid diet for a few days after the operation.
Robotic partial nephrectomy VS Laparoscopic partial nephrectomy
Robotic partial nephrectomy is more efficient than laparoscopic partial nephrectomy because the da Vinci surgical system has a lot of advantages.
Laparoscopic ureterolithotomy for a large 2.5cm proximal ureteral stone. After mobilization of the colon, identification of the ureter and dissection of the inflammatory region when the stone is impacted. Opening of ureter using cold cut in order to obtain a neat incision and prevent thermal damage to the ureter.
Laparoscopic Sacrocolpopexy, operated by Dr Fouad Khoury, in which he’sperforming a laparoscopic pelvic organ prolapse repair. This video features anterior plane dissection for Grade 4 bladder prolapse using polyester mesh placement and fixation to sacral promontory.
NB: Posterior plane repair should always be done in those cases, however, in this particular case, the patient had a previous rectocele repair 2 years ago by vaginal approach with no signs of current rectocele.
For more inspiring information regarding this matter, please visit the following link to watch Bladder Prolapse.
Dr Fouad Khoury, a referral urologist in Lebanon and the Middle East, performing pyeloplasty for UPJ stenosis. This video features step by step approach along with captions for successful and smooth completion of pyeloplasty operation, with antegrade intra operative JJ insertion.
The procedure was performed using 2x5mm and 2x10mm trocars. Smooth dissection of colon and identification of ureter and enlarged kidney pelvis. Once the proximal ureter is dissected without jeopardizing its blood supply, division and excision of UPJ stenosis. As you see, very minimal cauterization used in order to prevent scarring and possible re stenosis at anastomosis site. Therefore working in an oozing field should be tolerated in those cases.
Meticulous anastomosis was done using vicryl 4.0 starting with the posterior plane, followed by antegrade JJ 6Fr * 26cm inserted over guidewire. Once the JJ is placed, the anterior plane is completed using vicryl 4.0.
Laparoscopic NephroU done for management of upper tract TCC that was causing extensive bleeding and anemia for the patient. Due to advanced patient’s age (94 years old) and comorbidities, only a proximal ureterectomy was done after making sure that distal ureter is free of tumor in order to decrease operative time and surgical morbidity.
In the clip below, Dr Fouad Khoury demonstrates a laparoscopic left radical nephrectomy along with proximal ureterectomy.
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