Robotic surgery for kidney cancer

Periodic and annual examinations enabled the detection of kidney tumors at very early stages and in small sizes rather than at late stages. The curing goal is difficult at late stages and usually ends with the removal of the kidney by conventional surgery and undergoing further treatment to overcome the disease.

Now the technological revolution of robotic surgeries allows the control of kidney tumors of various sizes without a total kidney resection, providing the patient with higher tumor control, greater survival rate, and shorter hospitalization period to lead a normal life.

Robotic partial resection of the kidneys is an advanced process that needs a very specialized skill. Prof. Mahmoud AbdElHakim, Professor of Urology, Cairo University, has great control over the tumor because robotic surgery allows the simultaneous use of many surgical tools as surgical robots have 4 arms.

Partial nephrectomy: 
It involves the surgical removal of the cancerous part of the kidney. In this procedure, the tumor and a very small portion of the healthy kidney tissues are removed. The vast majority of healthy kidney tissue is preserved and surgically prepared so that blood and urine can flow normally. This is sometimes called "kidney-sparing" surgery. Maintaining kidney function is important because the kidneys are the body's primary filter, which is essential to life. 

Partial nephrectomy reduces the risk of long-term kidney failure, particularly if the other kidney is damaged. Therefore, partial resection works to preserve as much healthy kidney tissue as possible to avoid dialysis in the future, especially if the patient suffers from hypertension and diabetes.

Robotic-assisted partial nephrectomy:
In contrast to a traditional partial nephrectomy that requires a single big abdominal incision, a robotic-assisted partial nephrectomy needs several smaller incisions. The large incision of the traditional surgery is usually painful and may require partial rib removal.

The robotic technology enables the robot's arms to be programmed to maneuver more precisely in challenging bodily regions. Therefore it is less invasive than a traditional nephrectomy.
The urologist temporarily stops blood flow to the affected kidney before cutting off the cancerous area. The magnifying vision of the kidney and the ideal position of surgical instruments allow the surgeon to work and precisely control the removal of the kidney tumor, bleeding prevention, and then repairing the tiny blood vessels and kidney tissue that can be left.

Advantages of dealing with kidney tumors through robotic surgery:
As with most surgical robot-assisted procedures, it usually features the following:
- Maintaining the kidneys without affecting their functions.
- Less painful than traditional surgery.
- Less blood loss, so there is no need for blood transfusion.
- Less scarring due to the smaller incisions.
- Shorter hospitalization period, usually lasts only one day compared to a whole week in case of traditional surgery.
- The overall recovery time is shorter before returning to normal activities.


What happens before the robotic kidney surgery?
- General health check and vital signs measurements such as temperature, pulse, and blood pressure.
- Tell your doctor about your current medications, including herbal supplements. Aspirin, anti-inflammatory drugs, herbal supplements, and blood thinners can increase the risk of bleeding. Be sure to check with your doctor before stopping any medications.
- Also, tell the doctor about any allergies you have.
- Avoid all known allergens. These include medications, skin cleansers, and certain foods. 
- Your doctor will also give you specific directions about eating and drinking before your partial nephrectomy. You shouldn't eat or drink anything after midnight before the surgery. If you must take medications, take them with a small sip of water.

How is a partial robotic nephrectomy performed?
1- The anesthesiologist puts you under general anesthesia. You will not feel any pain during the surgery.
2- During a partial robotic nephrectomy, the doctor uses a scalpel to make small incisions in the abdomen, not more than 2 cm in size.
3- The doctor inserts a laparoscope and robotic surgical equipment into these small incisions.
4- The abdomen is first inflated with carbon dioxide gas to provide the surgeon with sufficient space to move the colon away from the kidney and to drive the surgical equipment till reaching the kidney. This gas is later expelled from the abdomen at the end of the surgery.
5- The surgeon controls the robotic devices as he sits at a control unit a few feet away from the patient's unit. The surgeon controls the robot's multi-jointed arms to perform dissection, cauterization, cutting, and suturing tasks. In addition, the surgeon controls a specific lens that provides an anatomical image with high 3D resolution.
6- Then, the affected kidneys are dissected and the tumor location is then imaged within the kidney using endoscopic ultrasound. This ultrasound allows a precise illustration of the tumor's boundaries within the kidney and permits the planning of an appropriate resection line to remove the entire mass.
7- The blood flow to the kidney is temporarily restricted to reduce blood loss during tumor resection.
8- The tumor, surrounding fat, and the edge of the healthy kidney tissues are removed, along with any visible surrounding lymph nodes.
9- Once the tumor is taken from the kidney, it is immediately placed inside a plastic bag designed to be properly removed later through one of the abdominal incisions. 
10- The kidneys are then closed with sutures with restoring the blood flow to the kidneys.
11- The doctor may install small silicone tubes at the incision sites to remove blood or fluids from inside the body. They are only kept there for a brief period of time.
12- Finally, the skin incisions are closed using plastic surgery techniques to reduce scarring.

What happens after robotic surgery for kidney cancer?
You must maintain a liquid diet for one to two days after surgery. A liquid diet helps give your body time to recover. As you recover, you'll gradually begin eating solid foods.
Your doctor will encourage you to get out of bed and walk on the day following surgery. Walking stimulates healing, enhances blood flow, and restores the injured areas' functions. It also helps prevent blood clots in your legs, exposing you to pneumonia or other complications. After two days, the assistant medical team of Prof. Mahmoud AbdElHakim will remove the urinary catheter.

One of the most important questions that occupy the minds of many patients is the need for complementary treatment after the robotic surgical removal of kidney tumors:
Prof. Mahmoud AbdElHakim, professor of Urology, Cairo University, confirms that the removal of kidney tumors is carried out with a high level of accuracy. This confirms that there is no need for further treatments such as radiotherapy or chemotherapy after surgery.