Jun 23, 2019
In this episode, we are “going retro.” Urologically speaking we are talking about the retroperitoneum, where the kidney lives. In this episode we are talking about a retroperitoneal robotic partial nephrectomy using the daVinci surgical robot.
We have talked about robotic partial nephrectomy on this podcast before.
In the standard robotic partial nephrectomy, the peritoneal cavity in the abdomen is entered and the kidney is exposed by moving structure off of it, the colon and other structures depending on the side we are working on in order to access the kidney, renal hilar blood vessels, and the tumor.
Once the kidney is exposed, ultrasonography and dissection of the fat off of the kidney allows us to find the tumor.
When we are ready to remove the tumor, the artery is clamped only during the dissection of the mass/tumor off of the rest of the kidney, and suturing the defect closed.
The procedure is usually complete in a couple hour surgical time, often requires only a night in the hospital, needs very small incisions because of the small instruments and laparoscopic cameras that we use. The robotic instruments give us excellent dexterity for sewing and our vision is heightened by the 6-10 times magnification of the camera. The procedure is able spare a large portion of the kidney that we are working on without compromising cancer cure.
But the surgical approach through the peritoneum has some limitations. The back side of the kidney can be hard to get to. To do that we often have to mobilize the entire kidney to “flip it over” to get to its posterior or back side.
The advantage a retroperitoneal approach, entering through the flank instead of through the front of the abdomen is that the back side of the kidney can be easier to access.