Our physicians tailor surgical treatment to each person and to the location and size of the kidney tumor. Because most newly diagnosed kidney tumors are small and confined to the kidney, NYU Langone doctors prefer a robotic-assisted surgical approach, which is minimally invasive, when feasible. The technique successfully treats these tumors and has significant cosmetic and recovery time advantages compared with open surgical approaches.
At NYU Langone, between the years 2008 and 2013, 926 total kidney cancer operations were performed—23 percent were radical nephrectomies and 77 percent were partial nephrectomies. In 2013, of the 191 surgeries performed, nearly four out of five people had a kidney sparing approach. Of these 191 surgeries, more then 90 percent were done using a minimally invasive technique.
Open surgery may be necessary for people who have large, complex, or advanced tumors invading nearby organs. In addition, a minimally invasive approach may not be possible in people who have had several previous surgeries or extensive scarring of the abdomen. These surgeries may involve the expertise of NYU Langone’s cardiac, thoracic, vascular, and general surgeons.
Open surgery requires the use of a traditional incision, either in the side of the body, the abdomen, or underneath the ribs.
One potential benefit of open surgery for partial nephrectomy is that it allows for placement of the kidney in an ice bath, which may minimize damage to the healthy portions of the organ during surgery. This may be required for people with only one kidney or who have a kidney with multiple tumors.
The length of hospital stay needed following open kidney surgery varies, depending on the extent of the surgery. It usually ranges from three to five days.
Laparoscopic and Robotic-Assisted Surgery
With laparoscopic surgery, a doctor makes several small incisions in the lower abdomen below the ribs. He or she places a laparoscope, a lighted tube with a tiny camera on it, through one incision. The device creates two-dimensional images of the kidney cancer and the surrounding organs. Surgical tools are placed through the remaining incisions. Laparoscopic surgery can reduce recovery time to a few days and result in less scarring than an open procedure.
Doctors at NYU Langone are pioneers in the most advanced surgical techniques, which use robotic assistance to laparoscopically treat kidney cancer. They perform more robotic-assisted partial nephrectomies than any other cancer center in the New York area. Over the past 5 years, 1,000 people with kidney cancer have been treated at NYU Langone, and nearly 80 percent had a partial nephrectomy. Ninety percent of these procedures were performed using robotic surgery.
This minimally invasive surgical “system” consists of tiny surgical instruments mounted on several robotic arms. An additional arm has a camera that generates magnified, three-dimensional images on a computer screen to help guide the surgeon during the operation. During the procedure, the surgical instruments and the camera are inserted through small incisions in the abdomen or side. The surgeon controls these instruments and the camera from a console located in the operating room.
Robotic-assisted laparoscopic surgery may have several advantages over open or traditional laparoscopic surgery. It uses smaller incisions than open surgery and doesn’t require cutting through muscle or bone. This results in less scarring and trauma and a faster overall recovery time—typically two weeks, as opposed to four to six weeks for the open procedure. Time spent in the hospital may be to one to three days with robotic-assisted surgery.
Research also suggests that, compared with traditional laparoscopic surgery for a partial nephrectomy, the robotic-assisted procedure may result in less blood loss, less damage to the kidney, and a shorter hospital stay.
Another benefit of the robotic procedure is that it enables the doctor to use new imaging technologies not available with laparoscopy, such as near-infrared fluorescence imaging. This technique allows doctors to locate the tumor and view surrounding structures, such as blood vessels, more easily.