Partial Nephrectomy (PN) for the world kidney day

By Dr. Anant Kumar in Urology , Robotic Surgery

Mar 24 , 2022 | 2 min read

Kidneys are very important organs and are working all the time to remove toxic and unwanted substances from the body. Thus, keeping us healthy. In elderly population, kidney function slowly deteriorates and we need both the kidneys to live normally. 

Kidney tumors are not a common tumour and usually involve the elderly population but also seen in young and middle aged. If detected in an early stage, it is curable. Routine use of the ultrasound has led to an increase in diagnosis of early tumors. In the past, most of the kidney tumors were treated by total removal of the involved kidney(Radical Nephrectomy), which may lead to reduction of total kidney function and some patients may develop chronic kidney failure in the long run. If a patient is diabetic, it is more important to save every filtering unit of the kidneys (Also known as Nephron) as diabetes leads to kidney failure in 50% of the patients in the long run. 

For the last 15-20 years, saving the uninvolved part of the kidney and removing tumor with one-centimeter normal tissue margin has become the new norm of the treatment of kidney tumors. Such an operation is known as Partial Nephrectomy(PN) or Nephron sparing surgery(NSS). Advantage of PN is curing the patient from the cancer and saving the kidney function. 

Kidney is a very vascular organ and gets 25% of heart output every minute. PN is done by stopping the blood supply of the kidney. Kidneys can live without blood supply for 30-40 minutes and after that kidney function starts deteriorating. PN was initially done by open method under hypothermia to preserve the kidney function as hypothermia may preserve kidney function for up to 2 hours. Open partial nephrectomy is a good operation but associated with significant morbidity, post operative pain and long recovery time. 

We have been doing laparoscopic PN for the last 18 years with very good results and started doing Robotic PN since 2012. Lap and Robotic PN are minimally invasive ( Keyhole surgery) surgery to remove kidney tumor and save uninvolved part of the kidney. Patients have less pain and fast recovery. He can go back to work early and there is no visible scar. Both these procedures are done without hypothermia , so you need to finish the operation within 30-35 minutes. We have been doing these procedures very often and complete the operation in 20-25 minutes. Our results are very good and comparable to the published literature. Recently our results of Robotic and Lap PN have been accepted in the Journal of Endourology. 

Robotic PN has some advantages over the laparoscopic PN due to wristed instruments and 3D vision. We have been doing very complex PN with the help of the Da Vinci Xi robot which was otherwise not possible to do with laparoscopically. Robotic surgery helps us complete the surgery within 15-20 minutes with minimal blood loss. 

So, the majority of kidney tumour patients can take the advantage of our experience and robotic facility at Max hospital to save kidney function and get cured by the cancer.