By Dr. Matthew Perry, Published in Vim & Vigor
Matthew Perry, M.D., a board-certified urologist at Florida Urology Specialists in Sarasota, with his new weapon against kidney cancer: the da Vinci Surgical System.
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A helping hand
The da Vinci robot’s three-dimensional visualization, along with enhanced dexterity and control functions, has made it one of the fastest-growing treatments for a range of urologic conditions. It is particularly suited for kidney surgery because open surgical approaches to the kidney tend to require large incisions with significant postoperative pain. Historically, the entire kidney was removed in patients with suspected kidney cancer. Two important advances have involved removing only the involved part of the kidney (partial nephrectomy) and laparoscopic total kidney removal—a minimally invasive procedure that significantly reduces pain and recovery time. “Da Vinci robotic-assisted laparoscopy achieves all the benefits of partial kidney removal with an entirely minimally invasive approach,” says Dr. Perry, a board-certified urologist at Florida Urology Specialists in Sarasota. “Many patients now do not have to choose between a painful open surgery to remove part of the kidney or a less painful laparoscopic surgery that sacrifices the entire kidney.” To preserve normal kidney function, urologists generally prefer a partial nephrectomy to a radical nephrectomy whenever possible. Studies show the increased range of motion and visualization of da Vinci robotic-assisted laparoscopic surgery make it well suited to the complexity and reconstructive nature of a partial nephrectomy. This includes partial nephrectomy for most tumors smaller than 4 centimeters and many tumors between 4 and 7 centimeters. For tumors greater than 7 centimeters in diameter, a total nephrectomy is often recommended.
Benefiting from robotics
“There’s no question it offers advantages over traditional laparoscopic surgery,” Dr. Perry says. “Traditional laparoscopy is like operating with chopsticks. It allows you to move instruments through small keyhole incisions by pivoting and moving them back and forth. But the robotic system has a number of added capabilities, including wristed instrumentation, that allow you to bend and maneuver around a tumor with a high degree of agility and precision. “The robotic system allows experienced surgeons to achieve the same cancer control and technical outcomes of open surgery, with the reduced pain and shorter recovery period of a truly minimally invasive surgery,” Dr. Perry says.
The treatment of choice
Other minimally invasive approaches are available to treat early stage kidney cancer and suspicious masses, including cryotherapy and radio-frequency ablation (RFA). Because these treatments can have higher local recurrence rates, many urologists prefer surgery for complete tumor removal. American Urologic Association guidelines encourage detailed counseling of patients who choose ablative therapies. “We offer ablative therapies for renal masses,” Dr. Perry says. “However, now that we can robotically remove tumors so safely and effectively, there are fewer patients for whom RFA or cryotherapy are the most optimal treatments.”
Vim & Vigor • Fall 2010 53
