Robot-Assisted or Laparoscopic Partial Nephrectomy

Dr Png Keng Siang
Consultant Urologist & Robotic Surgeon

Partial Nephrectomy

Partial nephrectomy, or kidney-sparing surgery, is a surgical technique designed to remove only the diseased part of the kidney, preserving as much of the healthy kidney as possible.

This procedure is ideally suited for removing smaller tumours, generally those less than 7 centimetres in size, while maintaining overall kidney function. It is especially beneficial for patients with solitary kidneys or bilateral kidney tumours, where total kidney removal could lead to renal failure.

Laparoscopic Partial Nephrectomy

Overview of Laparoscopic Technique

Laparoscopic partial nephrectomy (LPN) employs a minimally invasive approach to remove kidney tumours. This procedure involves small incisions and uses a laparoscope, a slender instrument with a camera, to give a detailed view of the kidney and allow precise surgical navigation.

Surgical Procedure

During LPN, the surgeon introduces specialised instruments through the incisions to access and excise the tumour. The kidney is carefully repaired using sutures, while real-time imaging assists in ensuring the accuracy of the tumour removal and the preservation of healthy kidney tissue.

Advantages of Robot-Assisted Surgery

This method offers several advantages, including:

  • Minimally Invasive: Smaller incisions facilitate quicker recovery and less pain.
  • Reduced Pain and Scarring: Minimises discomfort and cosmetic concerns.
  • Shorter Hospital Stay: Enhances recovery speed, reducing hospital time.
  • Less Blood Loss: Precision tools limit bleeding during surgery.
  • Lower Infection Risk: Fewer incisions decrease the chance of infection.

Postoperative Care and Recovery

After a laparoscopic partial nephrectomy, patients are typically advised to engage in light activities to promote healing while avoiding heavy lifting or strenuous exercise for several weeks.

Pain management is usually handled with prescribed medications, and follow-up appointments are crucial to monitor the healing process and renal function. Recovery times vary but most patients return to normal activities within a few weeks.

Robot-Assisted Partial Nephrectomy

Robot-assisted partial nephrectomy (RAPN) is an advanced, minimally invasive surgery that utilises robotic systems to enhance surgical precision and flexibility. A console controls the robotic arms with surgical tools and a high-definition 3D camera, providing superior visualisation and dexterity.

During RAPN, a few small incisions are made to introduce the robotic instruments into the patient’s body. The robotic arms, directed by the surgeon from the console, perform the tumour removal and kidney reconstruction with high precision. This method allows for meticulous dissection and suture placement, preserving kidney function.

This method offers several advantages, including:

Enhanced Precision: Robotic arms provide superior accuracy for complex tasks.

Improved Visualisation: 3D imaging offers a magnified, depth-enhanced view.

Ergonomic Benefits: Console operation reduces surgeon fatigue, potentially lowering error rates.

Quicker Recovery and Less Pain: Smaller incisions lead to faster healing and reduced discomfort.

Lower Risk of Complications: Enhanced control minimises surgical risks like blood loss and infections.

The recovery process for robot-assisted partial nephrectomy generally includes a short hospital stay followed by several weeks of home recovery.

Patients should gradually increase their activity, under medical supervision, watching for any complications. Pain is typically less than traditional surgeries, and follow-up visits ensure proper kidney function and wound healing.

Comparison of Robot-Assisted and Laparoscopic Techniques

Understanding the differences between robot-assisted and laparoscopic partial nephrectomy is crucial for choosing the most suitable surgical approach. Each technique offers distinct advantages in precision, visualisation, and patient recovery outcomes, tailored to the specific needs of the surgery and patient condition.

Precision and Flexibility

  • Laparoscopic: Offers precise surgery with limited manual range of motion.
  • Robot-Assisted: Enhanced precision and flexibility; robotic arms provide extended manoeuvrability.

Visualisation

  • Laparoscopic: Utilises a high-definition camera, providing clear but 2D views.
  • Robot-Assisted: Employs advanced 3D visualisation for depth perception and detailed viewing, crucial for complex surgeries.

Learning Curve and Operative Time

  • Laparoscopic: Requires substantial expertise; manual instrument manipulation can prolong surgery time.
  • Robot-Assisted: Demands initial training but often results in shorter surgeries as proficiency improves.

Patient Outcomes

  • Laparoscopic: Typically results in good outcomes, with reduced pain and recovery time compared to open surgeries.
  • Robot-Assisted: Potentially enhances patient outcomes by minimising complications and decreasing recovery times.

Dr Png Keng Siang

Consultant Urologist & Robotic Surgeon

Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.

  • Joint Committee of Specialist Training Site Accreditor, Urology Residency Program
  • President of the Robotic Surgery Society of Singapore
Prior To Private Practice:
  • Director of the Robotic Urological Surgery Fellowship Program, Tan Tock Seng Hospital
  • Director of the National Healthcare Group Urology Residency Program & Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine
  • Member of the American Urological Association, Endourological Society (USA)
  • Executive Committee of the Singapore Urological Association, 2013 to 2020
Read Full Bio

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    Robot-Assisted or Laparoscopic Partial Nephrectomy

    Frequently Asked
    Questions

    What is the ideal tumour size for partial nephrectomy?

    Partial nephrectomy is typically recommended for tumours smaller than 7 cm in diameter, as it allows for effective removal while preserving kidney function.

    Can partial nephrectomy be performed on any kidney tumour?

    While many kidney tumours are eligible for partial nephrectomy, the decision depends on the tumour’s size, location, complexity, overall health and kidney function of the patient.

    How long is the recovery period after a partial nephrectomy?

    Recovery times can vary, but patients generally return to normal activities within 3 to 6 weeks post-surgery. The exact time depends on the surgical method and the person’s health.

    Are there any dietary restrictions post-partial nephrectomy?

    Post-operative dietary guidelines may include reduced protein intake and careful fluid management, but the urologist should tailor specific recommendations based on the person’s needs.