Dear patient, if you are reading this, then you were likely diagnosed with a kidney abnormality such as a solid tumor or suspicious cyst that may be removed while saving the rest of the normal kidney. This type of surgery is called a “partial nephrectomy.”
There are various methods of doing this procedure. In the past, the only approach was to make a long cut on the side of the belly to get to the kidney. Then in the 1990’s, we began doing these procedures through small cuts in the belly (laparoscopically) with “chopstick” type of instruments. In the early 2000’s a new instrument came into play called the DaVinci robot that allows for wrist-like movements of the thin instruments that are placed through small cuts in the belly and are controlled by the surgeon with joysticks.
The robotic surgery allows for high definition 3-D view of the inside of the belly improving precision of the operation. Currently, the Robotic Partial Nephrectomy is the “gold standard” treatment for the removal of small kidney tumors. Dr. Gorbatiy spent an extra 2 years, after his residency, in an “exclusive” fellowship in Robotic Urologic Surgery. He has operated on several hundred patients with this type of surgery over the past decade at Broward Urology Center.
This guide is intended to explain how the procedure is done, how to prepare for it and what to expect after the procedure.
The kidneys are a pair of organs located towards the back of the belly (flank area). Each is about the size of a fist. The kidneys are essential organs, which filter the toxins from the blood and balance the water and salts in the body. As the kidneys filter blood, they create urine, which collects in a funnel-shaped structure called the “pelvis of the kidney” and leaves the kidneys down tubes called “ureters" to finally reach the bladder. The kidneys are essential to life.
Most kidney tumors are malignant, which means they are a kidney cancer. On average, 80% of tumors about 1.5 inches in size are malignant while 20% of those are benign tumors.
Partial Nephrectomy is considered to be the standard treatment for most smaller kidney tumors and in some larger masses that are in a “good” location. A partial nephrectomy means that a surgeon cuts the tumor out of the kidney and saves the rest of the normal kidney.
This surgery may be done these days through small holes in the belly (laparoscopically) as well as with the assistance of a “robot” machine that allows for the surgeon to control small laparoscopic instruments with joysticks. The surgeon must control the arms of the robot and the laparoscopic instruments attached to them. The robot does NOT function independently on its own. The robot has become an essential tool for this operation as it dramatically improved the safety and duration of the surgery compared to the traditional laparoscopic methods. In rare cases, the surgery may need to be done with the traditional large open incision.
The steps of the operation:
The operation takes 3-4 hours to complete. In cases where patients are obese, the tumor is large, the anatomy is difficult or there are multiple tumors, the procedure may take longer.
Most patients stay in the hospital for 2 days. The goal is to get you out of the hospital as fast as possible, when you are safe to go, so that you may avoid catching any hospital related infections. The most important step to a speedy recovery is to move as much as you can. The more you move, the faster the bowels wake up, and the less likely you will get blood clots in the legs. The following is the typical hospital course:
Immediately after surgery
Day #1 after surgery
Most patients are ready to go home when they have passed gas, pain is well controlled with pills, there are no signs of an infection and blood levels are good. When the doctor deems you to be safe to go home, we will remove the tube from the belly (this doesn’t hurt, just uncomfortable).
Most patients report that they feel like they are back to “normal” at about 2-3 weeks after the operation. Typically, patients feel that their belly is a bit swollen for a few weeks. The incisions may have some bruising. Male patients may feel some testicular discomfort on the same side of the kidney that was operated on. Some patients may feel like their bowels are not moving normally for a little while after surgery and many report feeling more tired for a few weeks.
The treatment options for solid kidney tumors besides a partial nephrectomy (starting with the least aggressive to the most aggressive option) include:
Active Surveillance - close monitoring with repeat imaging of the kidneys over time; Surveillance may be done with or without a diagnostic biopsy. This is usually reserved for very small kidney masses or for patients who are too ill for surgery.
Kidney Tumor Embolization - certain benign tumors (like Angiomyolipomas) are treated with this procedure where the Interventional Radiologist is able to cut off the blood supply to the tumor.
Kidney Tumor Ablation - either through the back (percutaneously) or laparoscopically (small belly opening), a special needle is used to penetrate the tumor and either burn it or freeze it to death.
Radical Nephrectomy - surgery to remove the entire kidney is reserved for larger kidney tumors and the smaller tumors which appear to involve the main blood supply to the whole kidney. This surgery is commonly done laparoscopically and at times with the assistance of the robot. For patients with very large tumors, the surgery may need to be done in a traditional open fashion with larger incisions in the belly and with the assistance of other surgical specialists.
If you are currently awaiting a robotic partial nephrectomy, it is essential for your own safety and for the success of your operation that you carefully read and observe these instructions.
Ten (10) days before surgery please STOP taking any Aspirin, NSAID’s (non-steroidal anti-inflammatory drugs) such as Ibuprofen, Motrin, Aleve, etc., Vitamin E, Fish Oil and any other blood thinners, including Herbal medications and multi-Vitamins.
If you are on Plavix (clopidogrel), Coumadin (warfarin) or any other prescribed blood thinner, make sure you mention this to Dr. Gorbatiy so we could have a clear permission from your primary doctor or cardiologist to stop those medications safely prior to surgery.
Take your usual doses of heart, thyroid, and asthma medications on the morning of surgery with a tiny sip of water. If you are diabetic and take medication, do not take them on the morning of surgery. If you take insulin, only use half the normal dose the morning of surgery.
In the days leading up to surgery, eat a healthy diet to help the body heal faster.
Please be more active prior to surgery, even 5 or 10 thousand extra steps in a day will increase your stamina and help you bounce back much faster after any operation.
Losing weight (even 5 pounds) helps patients recover faster as it makes the anesthesia easier to administer.
Quit, or at least cut down on smoking, alcohol or recreational supplements.
Stay positive. An optimistic outlook gives you energy toward a rapid recovery.
- What to Bring to the Hospital
We hope these instructions are useful to you. If there are any questions not covered by the instructions, please contact us at the above phone number. It has been a pleasure working with you to resolve your problem.
2150 South Andrews Avenue, Suite 100
Fort Lauderdale, FL 33316
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