Robotic Surgery for Kidney Cancer
Today, physicians at Mount Sinai are utilizing one of the most advanced surgical approaches to kidney cancer, minimally invasive robotic surgery, to safely and more precisely remove small tumors while leaving the rest of the healthy, functioning kidney in the body. Patients are benefiting from fewer complications and side effects, including smaller incisions, less scarring and post-surgical pain, shorter hospital stays, and faster recovery.
A pioneer in the use of minimally invasive robotic surgery for kidney cancer, Mount Sinai is one of the few medical centers in the United States where this procedure is offered. In the past, the standard of care for small tumors was to remove the entire kidney, a procedure known as nephrectomy. But partial nephrectomy (removing part of the kidney) and preserving as much kidney function as possible without compromising control of the cancer has emerged as the best approach for treating small kidney tumors (4 cm or less) in recent years.
F.A.S.T. Robotic Partial Nephrectomy
Dr. Ketan Badani, Director Comprehensive Kidney Cancer Program developed F.A.S.T. as a means to shorten partial nephrectomy ischemia time – This is a critical point when the kidney is without blood flow while the tumor is being excised and the kidney reconstructed. Historically robotic surgeries involved the surgeon plus any number of assistants that are called on to carry out important portions of the operation. In a F.A.S.T. robotic partial nephrectomy, the robotic surgeon never leaves the controls. Dr. Badani's technique takes certain steps out of the hand of the assistant, and put them back into the hands of the robotic surgeon. That shaves minutes off the procedure and reduces the amount of time in which blood flow to the kidney is stopped (ischemia time). If you have kidney cancer, that's better for your kidney, and better for you.
The robotic partial nephrectomy is already quite an advancement from the days when the entire kidney was removed to remove a tumor, and a FAST robotic partial nephrectomy is another milestone in curing cancer while preserving as much of the healthy, functioning kidney as possible.
The F.A.S.T. technique also allows the Mount Sinai team to perform robotic partial nephrectomies on increasing numbers of complex kidney tumors rather than having to remove the entire kidney. It is typical for surgeons to remove the entire kidney if the tumor is large, or close to key structures in the kidney. The F.A.S.T. approach allows us to safely and effectively save kidneys, even in these complex circumstances.
The benefits of F.A.S.T. include:
- Surgery is performed through small “keyhole” incisions instead of a major incision, resulting in less blood loss and a faster recovery
- Prolonged warm ischemia time (the time the kidney is cut off from blood flow) and operative time during robot-assisted partial nephrectomy can adversely affect kidney function and clinical outcomes. With F.A.S.T, ischemia time can be minimized and shortened by 50% (to an average of only 15 minutes).
- Robotic controlled ultrasound in real time provides the surgeon with enhanced visualization and tumor identification; the surgeon can see both the operative field and ultrasound images simultaneously.
- Immunofluorescence imaging allows the team to perform F.A.S.T, with selective arterial clamping. Instead of clamping the main artery, cutting the entire kidney off from blood flow, immunofluorescence imaging helps the surgeon find the specific branch that feeds the tumor. This artery can then be clamped and blood flow maintained to the rest of the kidney, eliminating ischemia time in most cases, depending upon tumor size and location.
Recovery and Post-Operative Surveillance
For most patients who undergo robotic kidney surgery, only one night in the hospital is necessary following surgery. Mount Sinai Health System offers optional private rooms with concierge service at our Mount Sinai and Roosevelt Hospitals locations. Dr. Badani sees all patients personally during the hospital stay and one week after surgery to check and discuss pathology results.
The typical recovery of robotic kidney surgery is about twice as fast as the open procedure. Time to return to work depends on the amount of physical activity required by the job, but ranges from one to four weeks. On average patients return to work and normal activities around three weeks. With respect to eating and drinking, patients are served a light dinner the night of surgery and should be eating normally within a day or two of surgery. Moderate exercise is encouraged and non-resistance exercises such as walking, jogging, and swimming can start after two weeks. We do not want patients lifting weights until three to four weeks following surgery.
Holistic Medicine /Diet and Nutrition/Acupuncture/Yoga
A key member of the Comprehensive Kidney Cancer Program is Jillian Capodice, LAC, Assistant Professor and Director of the Integrative Urology and Wellness Program at Mount Sinai. Jillian develops customized nutrition, exercise and stress management programs for patients to facilitate post-surgery recovery, coping with side effects, and to help them maintain the highest degree of wellness moving forward. Importantly, she can work with our patients to formulate a diet and nutrition plan that is “kidney healthy” after surgery. As obesity and high blood pressure are risk factors for kidney cancer, she also consults with individuals who are interested in working on lifestyle changes and disease management strategies.
Four or five months following surgery, patients are seen by Dr. Badani for imaging tests. This includes either a CAT scan or MRI to assess the kidneys and surrounding areas. A chest x-ray is also taken. The frequency of visits and surveillance tests depends upon tumor pathology (i.e., benign vs. malignant, aggressive, etc.). Generally, patients come in twice yearly for blood tests and once per year for imaging. Many patients have traveled to Mount Sinai for their surgery. These patients can have follow up tests performed near their homes. Dr. Badani stays in close personal touch with his patients’ personal physicians to ensure follow up is seamless and up-to-date.
Minimally invasive robotic surgery is not an option for all patients. The decision to proceed with robotic surgery depends on numerous factors, including the size, location and aggressiveness of the tumor, a patient’s medical profile and history, and the patient’s expectations and preferences.
We Can Help
If you or a loved one has been diagnosed with kidney cancer and you are interested in learning more about robotic kidney cancer surgery or would like to schedule an appointment, please call us at 212-241-4812.
Department of Urology
5 East 98th Street, 6th Floor
New York, New York 10029
Robotic Kidney Surgery
425 West 59th Street
New York, New York 10019