Open partial nephrectomy is the traditional operation for removing a particular part of the kidney. The surgeon makes a flank incision approximately 15-20cm (6-8 inches) long allowing enough room to remove the disease from a kidney. This is required if it is not technically possible or considered too difficult to remove part of the kidney using keyhole techniques.

Laparoscopic surgery is key-hole surgery that is performed without having to make a large cut (incision). Instead surgery is carried out through small key-hole instruments inserted into the abdomen via small incisions. Carbon dioxide gas fills the abdomen to enable vision of the internal organs.

This is laparoscopic surgery using robotic assistance through the small key-hole incisions. In this is technique a robotic system is placed beside you. Attached to this are 3 or 4 robotic arms; two/three for instrument attachments and the other arm for a high magnification 3D camera to allow the surgeon to see within you abdomen (tummy). The instruments are approximately 8 mm in diameter and permit very delicate and precise movements including suturing/stitching within the abdomen.

At present there are 29 Da Vinci® robotic systems available in the Australia and around 7 are offering partial nephrectomy. The Da Vinci® system is used extensively throughout the U.S. and Europe; it is being used currently in many different areas of surgery. Other procedures performed include radical prostatectomy or radical cystectomy for the removal of the prostate and bladder due to cancer.

Robot assisted laparoscopic partial nephrectomy is key-hole surgery to remove a diseased part from a kidney using the Da Vinci robotic system. The Da Vinci® robot has several advantages that may make it useful for partial nephrectomy in the treatment of kidney cancer.

The da Vinci® robot has an excellent optical system that provides high-definition imaging and a three dimensional (3D) view for the surgeon. The Chris O’Brien Lifehouse has the latest da Vinci robot, the Si Dual console. The da Vinci system also offers the surgeon improved dexterity as it uses intuitive operative controls to move instruments with greater a capability than standard laparoscopy would normally allow. These controls may allow for greater operative precision during the tumour removal and subsequent reconstruction (rebuilding) of the kidney during the laparoscopic partial nephrectomy procedure.

You will wake up with a catheter into your bladder, a wound drain from your tummy, and have 4-5 small wounds from where the robotic arm port sites have been made.

Once your procedure is completed you will be taken to the recovery department to be monitored by the staff before transfer back to the ward. Once you are stable then you will be transferred back to the ward. We do ask that while immobile and bed bound post operatively that you move your feet, wiggle your toes to help promote circulation in your legs.

Your catheter will remain in for approximately 24 hours, the drain will also come out generally after 48 hours. You will have blood tests on the first 2 days.

Your average length of stay for this procedure is 3-4 days.

You will be discharged when you have passed wind (flatus), you are mobilising safely, you are passing urine well, and your pain is well controlled on appropriate oral analgesics.

You will need to return for an outpatient appointment at the Wednesday renal cancer clinic with your consulting team to get the results from your surgery.