Laparoscopic Surgery for Treating Kidney Cancer
17,May 2023
Keywords :
Laparoscopic
Cancer
Surgery
Kidney
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- What is Laparoscopic Surgery for Kidney Cancer?
The surgery currently recommended consists of removing thewhole kidney (radical nephrectomy) or the tumour and surrounding tissue(partial nephrectomy or tumorectomy) by keyhole surgery – i.e. without theincision used in “open” surgery. Wherever possible, a partial nephrectomy ispreferred to maintain renal function.
Use of this method always depends on the stage and patient’sperformance status
As it is minimally invasive, keyhole surgery provides a lesspainful and quicker recovery with shorter hospitalisation and far less bloodloss, allowing patients to return to normal life much sooner than classicalsurgery.
- What is the Procedure?
Laparoscopic Partial Nephrectomy
This surgery is considered the gold standard forsmall lesions and involves the total removal of the renal lesion and adjacenttissue while preserving the remaining renal parenchyma.
The indications for performing this procedure can be:
What is the Post-Treatment?
Patients who undergo surgery (both radical and partialnephrectomy) are provided with regular medical follow-up.
Medical assessment is provided for a period of at least 5years. During this time, various diagnostic tests are requested to establishwhether there has been a recurrence of the tumour and, if so, to detect it asquickly as possible.
- Laparoscopic surgery for kidney tumours, like all keyholesurgery, involves making small millimetre-sized incisions in the patient’sabdomen to insert the surgical instruments.
- One of these instruments is a laparoscope with a videocamera which films the patient’s inner abdominal cavity. This allows thesurgeon to operate via a TV screen.
- The kidney is fully removed (or partly in the case ofpartial nephrectomy) via an incision which is widened so the organ (or part ofit) can be extracted.
- This type of surgery may not be feasible for removal of verybig tumours that invade the tissue around the kidney or the venous structures,like the inferior vena cava.
- It is now possible to perform this type of surgicalprocedure with a robotic aid, providing more precise operation of theinstruments. However, in radical nephrectomy, robotic aids do not make asignificant contribution. In partial nephrectomy, they can make surgerysimpler, but they are not essential, unlike other situations.
- Laparoscopic Radical Nephrectomy
- Radical surgery was popularised by Robson in 1969 andconsists of removing the total kidney, Gerota’s fascia and perirenal fat(enveloping the kidney), suprarenal gland and lymph glands of the “renal hilum”(beside the renal artery and renal vein).
- It is used for large lesions or those for which partialsurgery is not feasible, and in patients with metastatic disease and good performancestatus.
- Absolute – in the event of a single kidney or a bilateralneoplasm;
- Relative – presence of a pathology that affects renalfunction;
- Elective – small lesions (T1a) and a normal contralateralkidney.
- In elective uses, the rates of recurrence and survival aresimilar to radical nephrectomy.
- When partial keyhole surgery is performed, a vascular clampis normally used on the blood vessels that irrigate the kidney, minimising lossof blood and facilitating the procedure.