Renal Cell Carcinoma Surgery

Renal cell carcinoma surgery includes radical nephrectomy, partial nephrectomy, and kidney tumor cryosurgery. The original renal cell carcinoma kidney surgery is the open (manual) radical nephrectomy (surgical removal of a kidney). By removing the kidney the renal cell carcinoma is removed from the body. If the renal cell carcinoma has not left the kidney and gone into other organs then nephrectomy has a good prognosis. To remove the kidney in an open radical nephrectomy an incision is made just below the rib cage and the urologic surgery is carried out by a team of surgeons and scrub techs. A radical nephrectomy can include removing the kidney, adrenal gland located on top of the kidney, lymph nodes, and fatty tissue surrounding the kidney.

Renal cell carcinoma surgery may involve removing just the cancerous renal mass. This partial nephrectomy has the advantage of keeping the kidney which keeps the blood filtering and producing urine. The requirement is a small kidney mass and that it is not located in the renal pelvis or center of the kidney. A kidney mass that is 1 ½ inches or less is a good candidate for a partial nephrectomy. Performing a partial nephrectomy is more complicated the a simple nephrectomy but the long term benefits of keeping the working kidney are beneficial in the long term, which is why Dr. Bianco and Dr. Gheiler have become experts in the partial nephrectomy.

Renal cell carcinoma surgery has advanced with three new methods since the original days of an open nephrectomy only option. Laparoscopic surgery is performed with several surgical instruments each one at the end of 12” to 18” poles. On one end of the laparoscopic instruments is the camera’s lens, grasper, scalpel, cautery, and other tools that can be replaced with each other and the other end has the grips to control the surgical instruments while watching the cameras view on a monitor. This means that only three to four tiny incisions need to be made to perform the nephrectomy or partial nephrectomy. The advantage is that there is less bleeding, a faster recovery time, less pain after the surgery, and smaller scars. The disadvantage is that not all urology specialists perform this surgery. Laparoscopic partial nephrectomy is also performed by Dr. Bianco and Dr. Gheiler.

Renal cell carcinoma surgery now includes freezing (cryosurgery) the kidney mass when it is 1 ½ inches and not next to the renal pelvis or against a major artery. Just as the partial nephrectomy allows the kidney to be saved, so does the cryosurgery of the kidney mass. By placing a thin cryosurgical probe into the kidney mass gas is run through it which then freezes the entire cancerous kidney mass. Then another gas is run through the cryoprobes which thaws the ice ball kidney mass. The again the kidney mass is frozen a second time and again thawed out. It is the thawing process that kills the renal cell carcinoma tissue.

The last improvement to renal cell carcinoma surgery was the advent of da Vinci surgery or robotic surgery. Dr. Fernando Bianco is the Chief of Robotic Surgery for the Columbia University Division of Urology at Mount Sinai Hospital in Miami Beach Florida. Da Vinci surgery is a laparoscopic procedure that uses an advanced robotic system to hold and control the surgical instruments while giving Dr. Bianco a magnified three dimensional view of the surgical site. Dr. Bianco has the ability to make small smooth micro movements with the da Vinci surgical system, while eliminating the negative actions of human shaking or drifting of the laparoscopic instruments during the hours of surgery. Robotic surgery also allows the suturing to be performed very accurately.

Renal cell carcinoma surgery with the da Vinci surgery system has many advantages but it also has a steep learning curve. Most urologic surgeons do not perform da Vinci nephrectomy or da Vinci partial nephrectomy and another determining factor is the robotic surgical experience that your surgeon has. Dr. Bianco performs da Vinci nephrectomy and da Vinci partial nephrectomy, laparoscopic nephrectomy, and open nephrectomy surgery. As the chief of robotics Dr. Bianco also trains urology specialists in other robotic procedures such as da Vinci prostatectomy, a prostate cancer surgery and for extremely enlarged prostates, the bladder surgery da Vinci cystectomy (bladder removal), da Vinci partial cystectomy and the kidney surgery to repair a dismembered ureter-pelvic junction called a da Vinci pyeloplasty. Dr. Bianco has performed over 300 robotic and laparoscopic surgeries.

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