Open, Laparoscopic, and Robotic Partial Nephrectomy Surgery
An open surgery is the original way of performing an operation which means manually performing the surgery with a scalpel to open up the body to get to the organs, in this case the kidney. Surgery started with the cave man, which can be seen on cave paintings, dating from the end of the Stone Age or “New Stone Era” that show surgery on the head being performed by scraping or drilling into the skull. As time progressed, surgical instruments, anesthesia, cauterizing, and infection control improved. Today we have sterile operating rooms, surgical teams, and a lengthy history of what works and what doesn’t. An open radical nephrectomy surgery or open partial nephrectomy uses a 6” to 10” incision, below the rib cage, in either the abdomen or flank area. The advantage of an open partial nephrectomy is that many urologic surgeons are qualified to perform this kidney saving surgery. The recovery time for most open surgery procedures is longer than laparoscopic or robotic surgery. The length of time the patient needs to stay in the hospital is a little longer and recovery time at home is generally longer.
Laparoscopic surgery was performed on animals in 1901 and on humans in 1910. As the decades went by, improvements, such as digitized video cameras, allowed the entire operating room staff to view the surgery on a monitor. A laparoscopic surgical instrument is simply a grasping, cutting, cauterizing, or suturing device that is on the end of a pole that that can be 10 to 18 inches long with handles that manipulate the instrument. Another pole has a video camera so the surgeon can see the surgical site. Laparoscopic partial nephrectomy is performed by making several small 1 centimeter slits and placing the video camera and surgical instruments into the body cavity. CO2 is pumped into the body blowing up the area so that the instruments can move around and the video camera can see all areas of the surgical site. This type of minimally invasive surgery leaves only a few tiny scars, less blood loss then open surgery, a shorter hospital stay, and shorter recovery period. Unfortunately fewer urologists perform laparoscopic surgery because there is a higher learning curve.
Robotic surgery is the same as laparoscopic surgery except a medical robot assists the surgeon with the laparoscopic instruments. The da Vinci surgery robot is in over 1,500 operating rooms around the world and is used by gynecologists, cardiologists, general surgeons, and urologists. The advantage in having a da Vinci partial nephrectomy over a manual laparoscopic partial nephrectomy is that da Vinci surgery has magnified 3D video imaging that can zoom in and pan out, along with micro-fine movement control of the surgical instruments. Instead of standing up and holding the long laparoscopic poles for an hour or two the robotic surgeon sits down at a console and performs the partial nephrectomy. These features help make for a subtler surgical experience along with the benefits of less blood loss, less scaring and quick hospital stay, and recovery time. Our staff of urological robotic surgeons, also perform da Vinci prostatectomy, robotic cancer bladder removal (cystectomy), and da Vinci pyeloplasty.