NYU Langone doctors may treat kidney cancer with one of several surgical approaches. They often use minimally invasive robotic-assisted techniques. Our doctors pioneered the use of robotic-assisted surgery for treating kidney cancer, and perform more of these surgeries than any other medical center in New York. To date, our physicians have taught surgical techniques to more than 1,000 urologists from around the world.
Types of Surgery
Your doctor may recommend a partial nephrectomy or a radical nephrectomy to remove a cancerous kidney tumor.
Removing only part of the kidney is called a partial nephrectomy. This approach helps preserve kidney function and is often as effective as removing the entire kidney for treating the cancer. Our doctors use this approach whenever possible, making the decision based on the features of the kidney tumor.
Preserving the kidney is important for several reasons. Although people can function with just one kidney, they may already have or develop other common conditions as they age, such as high blood pressure or diabetes. Both of these conditions can strain the remaining kidney, resulting in chronic kidney disease.
For example, high blood pressure can damage the blood vessels in the kidneys, decreasing the levels of oxygen and nutrients needed for the organs to filter the blood. With diabetes, high blood sugar levels can damage the kidneys and possibly lead to kidney failure and the need for dialysis or transplant.
Studies conducted by NYU Langone doctors have shown that performing a partial nephrectomy to remove a small tumor—one that’s less than 4 centimeters across—is just as effective as removing the entire kidney for treating the cancer and preventing it from returning.
At NYU Langone, our surgeons also specialize in performing partial nephrectomy on larger tumors to help spare as much of the healthy portion of the kidney as possible. Our doctors can discuss whether this approach is right for you.
During a partial nephrectomy, a doctor removes the tumor with a margin of surrounding healthy tissue, which ensures that all of the cancer has been removed. To remove the least amount of tissue necessary, NYU Langone doctors use imaging techniques to guide the surgery, including intraoperative ultrasound or fluorescence imaging, an advanced technique that uses special infrared technology to identify anatomical structures.
Doctors may have a pathologist examine the tumor and surrounding tissue immediately after it is removed in the operating room to ensure there is a clear margin, meaning a border of healthy cells surrounding the cancer. NYU Langone surgeons are able to achieve a clear margin more than 98 percent of the time, one of the best rates nationally. In addition, our doctors are developing newer techniques and approaches to minimizing any collateral damage to the kidney during surgery.
Doctors may remove the entire kidney, in a procedure called a radical nephrectomy, to manage large kidney tumors or cancer that has spread to nearby tissues. In addition to removing the kidney, a doctor may also remove area lymph nodes, which are small immune system glands. Kidney cancer, in rare cases, can spread to the lymph nodes first.
During a radical nephrectomy, the doctor removes the surrounding fatty tissue, and, in special circumstances, the adrenal gland, a small organ that sits on top of each kidney and produces many of the body’s important hormones, including cortisol, which helps you respond to stress, and aldosterone, which regulates blood pressure. When one adrenal gland is removed, the other one takes over hormone production.
Our doctors 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 than 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.
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.