In addition to traditional open surgery for the disease, a less extensive and invasive alternative exists: laparoscopic surgery, which offers the benefits of a less invasive procedure but is also technically more difficult to perform. With the addition of robotic technology to laparoscopic surgery, certain limitations of laparoscopic surgery may be overcome and the options in surgery for RCC may continue to expand.
Renal cell cancer is typically treated with one of two surgical options, depending on the extent of spread of disease: 1) surgery to remove entire kidney, local lymph nodes, and any cancer in the area surrounding the kidney (radical nephrectomy); or 2) less aggressive surgery to remove only the part of the kidney affected with cancer (partial nephrectomy). Surgery is the standard treatment for RCC because the disease is typically resistant to radiation and chemotherapy. Patients who are unable to tolerate surgery, however, will not undergo either radical or partial nephrectomy.
Both radical nephrectomy and partial nephrectomy may be conducted using laparoscopy. In the case of a radical nephrectomy, the incision is enlarged to allow passage of the kidney. With a partial nephrectomy, a small bulk of tissue is removed and the incision can remain small.
During a laparoscopic surgery for RCC, the surgeon makes small, one-centimeter incisions in the abdomen and side. The surgeon then inserts a very small tube that holds a video camera, which creates a live picture of the inside of the patient’s body. This picture is continually displayed on a television screen, so that surgeons can perform the entire surgery by watching the screen.
If proven effective robotic technology will offer an additional option in laparoscopic surgery for RCC. Although robotic-assisted laparoscopic nephrectomy is still under investigation, its potential advantages include requiring less extensive surgeon experience than non–robotic laparoscopic procedures, allowing a greater number of surgeons to perform the procedure with high accuracy, which could bring laparoscopic radical and partial nephrectomy into more-widespread use. Ongoing research will continue to investigate the accuracy of robotic-assisted laparoscopic nephrectomy and associated outcomes as well as identify which RCC patients will experience the best results with this procedure.