Robotic partial nephrectomy

Partial nephrectomy is performed for kidney cancer and involves removing just the tumour from the kidney, preserving the kidney itself.  As the kidney is a very vascular organ, constantly filtering blood, this needs to be performed using a technique that avoids heavy bleeding and also the leak of urine from where the kidney has been deeply incised.  The surgery therefore requires temporarily clamping the blood flow to the kidney so that the tumour can be completely removed, then the kidney closed carefully before the clamp is removed.

Robotic surgery is a method that allows this complex operation to be performed through keyhole surgery.  With the magnified vision and dexterity of robotic instruments, larger and deeper tumours than previously thought possible can be removed and the kidney preserved. 

To see video of an actual robotic partial nephrectomy CLICK HERE or see below.

A/Prof Moon published the first series of robotic partial nephrectomy in Australia [1] and regularly teaches this technique to surgeons at National and International workshops.   In 2018 Dr Moon published the largest  Australian study of partial nephrectomy for kidney cancer demonstrating significant benefits of robotic surgery compared to the traditional open approach.  He has collaborated with surgeons in London to present data on this technique [2] and has joined an international consortium analyzing outcomes of robotic partial nephrectomy from additional high volume centres in Europe, North America and Asia, with multiple scientific papers produced and presented [3-6].  

In 2021 A/Prof Moon then published an international multicentre series showing that robotic surgery can be used even in high risk situations where kidney function is poor or only one kidney is present.  These patients previously may have been facing open surgery or lifelong dialysis but with robotic techniques can now be offered a keyhole operation to remove the cancer with less complications, faster recovery, and preserved kidney function

To watch a video presentation demonstrating the surgical techniques in such cases CLICK HERE.

WARNING THIS VIDEO CONTAINS ACTUAL SURGICAL FOOTAGE

 

CLICK HERE to read an editorial in the British Journal of Urology published by A/Prof Moon outlining the current state of robotic kidney surgery.

A

B

CT scans showing a patient with tumours in both kidneys (Figure A) and following successful removal through robotic surgery (Figure B)

Large central cancer within a solitary kidney.  This was removed with robotic surgery by A/Prof Moon and the patient discharged in 3 days with preserved kidney function

1. Papachristos A, Basto M, Marvelde L, Moon D.  Laparoscopic versus Robotic-assisted radical prostatectomy: An Australian single surgeon series.  ANZ J Surg 2015 Mar; 85(3): 154-8
2. Kadirvelarasan A, Malthouse T, Belfrage S, Nehikhare O, Chakravorty M, Lam W, Doeuk N, Ahmed K, Moon D, Challacombe B.  Pushing the boundaries of robotic partial nephrectomy: A multi-centre comparison of the functional an oncological outcomes for T1a and T1b tumours.  J Endourol 2015; 29 (Suppl 1), p25
3. Novara G, La Falce S, Abaza R, Adshead J, Ahlawat R, Buffi NM, Challacombe B, Dasgupta P, Moon DA, Parekh D, Porpiglia F, Rawal S, Rogers C, Volpe A, Bhandari M, Mottrie A.  Robot-assisted partial nephrectomy in cystic tumors: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. BJU Int (In Press, epub Aug 25 2015)
4. Dalela D, Barod R, Sood A, Ahlawat R, Rawal S, Challacombe B, Porpiglia F, Moon D, Buffi N, Larcher A, Parekh D, Novara G, Volpe A, Mottrie A, Abaza R, Rogers C.  Perioperative and functional outcomes of robot-assisted partial nephrectomy for renal tumors >4 cm in a multi-institutional, multinational cohort. Eur Urol Suppl April 2015; 14(2): e923
5. Larcher A, Abaza R, Mottrie A, Ahlawat R, Buffi N, Moon D, Porpiglia F, Rawal S, B Challacombe, Fossati N, Dalela D, Novara G, Volpe A, Rogers C.  Predicting perioperative outcomes of robot assisted partial nephrectomy: The role of hospital case volume in the early phase of adoption.  Eur Urol Suppl April 2015; 14(2): e924
6. Dalela D, Barod R, Sood A, Bhandari M, Ahlawat R, Rawal S, Challacombe B, Porpiglia F, Moon D, Larcher A, Parekh D, Novara G, Mottrie A, Volpe A, Abaza R, Rogers C.  Impact of annual surgical volume on outcomes of robot-assisted partial nephrectomy in a multi-institutional multinational cohort. Eur Urol Suppl April 2015; 14(2): e923-923b