Robot-assisted technique improves surgeons' ability to remove small kidney cancer tumors

July 11, 2014, University of California, Los Angeles
Robot-assisted technique improves surgeons' ability to remove small kidney cancer tumors
Schematic showing the robotic device's proper position during surgery.

Roughly 50,000 Americans are diagnosed with kidney cancer each year. Most of them have small tumors that doctors discover while screening for other health problems.

The surgeries to remove renal tumors can be difficult, particularly if the cancer is on the posterior side of the and if patients have had previous abdominal surgery, because scar tissue from previous operations usually makes it hard for surgeons to distinguish the normal parts of the body from one another.

Now, a study led by Dr. Jim Hu and researchers at UCLA's Jonsson Comprehensive Cancer Center has shown that a newer surgical technique called robot-assisted retroperitoneoscopic partial nephrectomy is more effective than other current techniques to remove when the masses are located on the back of the kidney or when a patient has had previous . RARPN is a minimally invasive laparoscopic procedure in which surgeons use precise robotic arms and magnified, high-definition 3-D cameras.

The study, published online in European Urology, was the largest multicenter study to date on this technique. The five-year project reviewed surgeries for 227 patients whose average age was 60, with most between ages 52 and 66.

Currently, most surgical centers use a technique called thermal ablation, in which a heat-producing probe is used to eliminate small renal masses that are otherwise difficult for surgeons to reach. However, patients who undergo thermal ablation are eight times more likely to need CT scans after surgery so doctors can track whether the tumors return—and each additional CT scan exposes the patient to additional harmful radiation.

The study also found significant variation among surgeons using the robot-assisted technique in the amount of time the renal artery, which provides the main blood supply to the kidney, was blocked off during surgery. Depending on the surgeon, this time—known as the warm ischemia time—varied by as much as five minutes, even though all of the surgeons in the study were fellowship-trained, high-volume surgeons. More experienced were more likely to have shorter warm ischemia times, however. This finding is significant because when blood flow to the kidney is blocked for a longer time during , patients are more likely to suffer complications such as and long-term .

The researchers also found the frequency of surgical complications varied greatly from one surgeon to another, with some recording complication rates that were three times higher than those with the fewest incidents. However, major complications were relatively uncommon: Only three patients in the study required blood transfusions. And cancer recurred in less than 1 percent of the patients in the study.

"These differences in warm ischemia times may be attributable to slight variations in surgical technique," said Hu, who is also director of and holds the Henry Singleton Chair in Robotic and Minimally Invasive Surgery at UCLA. "But we showed center-specific variations in the RARPN approach and we present a video on surgical technique to highlight our approach."

Explore further: Study: Kidney cancer patients preserve kidney function with robot-assisted partial nephrectomy

More information: "Technique and Outcomes of Robot-assisted Retroperitoneoscopic Partial Nephrectomy: A Multicenter Study." Jim C. Hu, et al. European Urology, May 2014. PII: S0302-2838(14)00409-6. DOI: 10.1016/j.eururo.2014.04.028

Related Stories

Study: Kidney cancer patients preserve kidney function with robot-assisted partial nephrectomy

January 13, 2014
Patients with chronic kidney disease who received robot-assisted partial nephrectomy to treat kidney cancer have minimal loss of kidney function—a smaller amount even than patients with normal kidney function, according ...

Study: 'Icy' technique improves robotic kidney transplants

January 21, 2014
A collaboration of surgeons at Henry Ford Hospital and Medanta Hospital in India successfully transplanted kidneys into 50 recipients using an innovative robot-assisted procedure in which the organ is cooled with sterile ...

New technique for minimally invasive robotic kidney cancer surgery

December 13, 2012
Urologists at Henry Ford Hospital have developed a new technique that could make minimally invasive robotic partial nephrectomy procedures the norm, rather than the exception for kidney cancer patients. The technique spares ...

New cooling technique for robotic surgery performed on difficult kidney stone

August 27, 2013
A first-ever technique using ice slush and minimally invasive robotic surgery to remove a particularly large type of kidney stone has been reported by urologists at Henry Ford Hospital.

Minimally invasive surgery underused at many US hospitals

July 8, 2014
Hospitals across the country vary substantially in their use of minimally invasive surgery, even when evidence shows that for most patients, minimally invasive surgery is superior to open surgery, a new study shows. The finding ...

Recommended for you

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

Dulling cancer therapy's double-edged sword

January 17, 2018
Researchers have discovered that killing cancer cells can actually have the unintended effect of fueling the proliferation of residual, living cancer cells, ultimately leading to aggressive tumor progression.

Presurgical targeted therapy delays relapse of high-risk stage 3 melanoma

January 17, 2018
A pair of targeted therapies given before and after surgery for melanoma produced at least a six-fold increase in time to progression compared to standard-of-care surgery for patients with stage 3 disease, researchers at ...

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

Researchers identify new treatment target for melanoma

January 16, 2018
Researchers in the Perelman School of Medicine at the University of Pennsylvania have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.