Robotic Kidney Surgery At Genesis
Using the da Vinci® Surgical System
A new robotic procedure being performed at Genesis Medical Center, Davenport not only removes small kidney tumors while sparing the healthy part of the kidney but also brings a quicker recovery for patients.
Urologist Dr. Tim Kresowik has performed several robotic partial nephrectomies using the da Vinci Surgical System and is happy with his patients’ outcomes.
Using the robot, he says, allows him to be more precise than in an open procedure; gives him a 3-D, high-definition view of the surgical field; requires smaller incisions; reduces blood loss; and, shortens the patient’s hospital stay by three to four days.
Previously, many renal masses have been treated by a radical nephrectomy, which meant removing the entire kidney. With a partial nephrectomy, however, much of the kidney can be preserved, and with it, kidney function in most patients. In fact, studies show cancer outcomes are the same whether the entire kidney, or just part of the kidney, is removed.
Partial nephrectomy has historically been an open procedure performed through a large, 6-8-inch incision rather than with laparoscopy because the surgeon needs to be able to have control of the major blood vessels to the kidney to prevent bleeding. Recovery time for such a major operation was lengthy and difficult.
“When we do a partial nephrectomy, we’re removing only part of the kidney,” says Dr. Kresowik of Urological Associates, P.C, who trained in robotic surgery at the University of Iowa. “It’s a difficult operation because the kidneys are very vascular organs and receive about 15 percent of the blood flow.
“The challenging parts of the procedure are to clamp the vessels, the artery and vein that lead to the kidney so that our operative field does not fill up with blood. We also have to isolate the mass and take out just that part of the mass without getting too deep into the kidney.”
With a robotic partial nephrectomy, only several, tiny incisions in the abdomen are required for the slender robotic arms and tiny surgical tools. This minimizes bleeding, speeds recovery and maximizes preservation of renal function.
“With an open partial nephrectomy, patients are looking at four or five nights in the hospital, as compared to robotic surgery, where we can usually get them out of the hospital the next day,” Dr. Kresowik says.
During the procedure, he remotely guides the da Vinci’s robotic arms while seated at the console, located a short distance away from the patient. His movements are replicated by the robotic arms, which are stationed over the patient. One arm is equipped with a 3-D magnification camera; two act as the surgeon’s arms.
“Robotic surgery has several advantages over conventional surgery,” he says. “In an open procedure, my wrists can only rotate so many degrees when I’m suturing. The robot can actually rotate almost all the way around, which gives me a lot more flexibility with the suture.”
The da Vinci’s highly magnified vision system and dexterous instrumentation allows the surgeon to have complete vascular control and reconstructive results.
“Renal masses can be benign or malignant,” Dr. Kresowik says. “However the majority of them represent a kidney cancer, which can grow and has the potential to spread, so it’s important that you get a margin around the cancer mass that you’re removing while still preserving as much of the normal kidney as possible.
“Previously, a lot of these masses were treated by removing the entire kidney. The benefits of a partial nephrectomy are that you preserve most of the kidney, and you can preserve kidney function in most patients.”
The da Vinci Surgical System provides an effective, minimally invasive alternative to both open surgery and laparoscopy for complex surgical procedures.
Dr. Kresowik also uses the da Vinci for prostate removal surgery, and says he’s happy with the outcomes experienced by his first partial nephrectomy patients. He sees more uses for the da Vinci system. Although he does about 75 percent of his operations with the robot, he says there will always be a role for open surgery. He hopes to continue building the robotic program at Genesis.
“I can remove entire kidneys this way,” he says. “People are beginning to use the da Vinci to remove bladders and doing pediatric and reconstructive urological procedures. There are also many applications in gynecology, general surgery and otolaryngology.”