New for kidney cancer: robotic surgery

Surgery to remove a kidney tumor is no longer a hands-on operation. Sam Bhayani, M.D., a urologic surgeon at the Siteman Cancer Center at Washington University School of Medicine in St. Louis, has pioneered robotic surgery for kidney cancer. Instead of standing for hours with his arms raised above the patient, Bhayani sits at a nearby computer console to maneuver joystick-like controls that guide robotic scalpels, scissors and high-resolution cameras.

WUSM surgeon Sam Bhayani demonstrates a less invasive type of robotic kidney surgery that was pioneered at the School of Medicine. This type of minimally invasive procedure provides a number of benefits for the patient.

For patients, robotic surgery means less pain, smaller scars, minimal blood loss and a faster return to normal activities. Moreover, the procedure preserves the function of the healthy portion of the kidney, unlike the standard “open” surgery, which typically involves removing the entire organ.

“Robotic surgery is more efficient and precise than either open or laparoscopic surgery for tumors confined to the kidney,” says Bhayani, assistant professor of surgery and a leader in the field of robotic surgery. “Rather than operate with two hands, I can simultaneously control four robotic instruments with mechanical “wrists” that rotate more than 360 degrees, giving me far greater maneuverability than human hands or laparoscopic instruments.” Bhayani led a team at Washington University to develop the procedure for kidney tumors.

The computer-controlled system also eliminates surgeons’ hand tremors, however minute. And the robot provides an exceptional view of the surgical field. The surgeon sees the tumor and surrounding structures in high magnification. Dual miniature cameras restore the depth perception of an “open” surgery, which is lost in standard laparoscopy.

Robotic surgery has traditionally been most used to remove cancerous prostate glands and for certain cardiac surgeries, but Bhayani saw the potential to adapt the technology for removing kidney tumors. Since May 2007, he has performed nearly 100 robotic surgeries for kidney cancer at Barnes-Jewish Hospital. Patients who have had the robotic procedure have quicker recoveries than with open surgery – one day in the hospital versus five. Because surgeons remove the entire tumor using robotic surgery, there’s no need for further chemotherapy or radiation treatments, he says.

For decades, removing the entire kidney has been the standard surgical treatment for kidney tumors that have not spread. More recently, some surgeons have become adept at removing kidney tumors laparoscopically with long slender instruments inserted through small incisions. But even when this minimally invasive procedure is performed, the whole kidney is often excised. That’s because the laparoscopic procedure to remove only the kidney tumor is technically challenging, slow and awkward – it is difficult for the surgeon to visualize the tumor using a single camera, which creates a two-dimensional image and reverses the surgeon’s movements. In addition, the laparoscopic instruments have limited mobility.

“It’s like driving a car with a steering wheel locked in one position vs. being able to move the steering wheel in any direction,” Bhayani says. “That’s one big advantage of the robot.”

Additionally, robotic surgery to remove only the tumor and surrounding tissue dramatically decreases the likelihood that the patient eventually will develop renal failure. Some 60 percent of patients who have their whole kidney removed develop renal failure, compared to 15 percent who have only a portion of the kidney removed, Bhayani says.

Robotic surgery also appears to be superior to partial kidney removal performed laparoscopically because of the shorter amount of time blood flow to the organ must be stopped so the tumor can be excised – about 20 minutes for robotic surgery compared to 30 to 40 minutes for laparoscopic surgery. The longer the blood flow is cut off, the greater the risk that the kidney will not function normally after the surgery.

An estimated 55,000 cases of kidney cancer will be diagnosed in 2008. The cancer is on the rise because more kidney tumors are being detected inadvertently when patients have CT scans or MRIs for other concerns.

Bhayani says robotic surgery is the wave of the future for kidney cancer patients. While relatively few surgeons know how to use robotic surgery to remove kidney tumors, he is training numerous surgeons to use the procedure.

Washington University urologic surgeons also perform robotic surgery for prostate, bladder and testicular cancer. For more information about robotic surgery for urologic cancers, please call (314) 362-8212.

Dr. Bhayani is a consultant for Intuitive Surgical, and receives honoraria for surgeon education.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.