Clinical Briefing: Robotic Partial Nephrectomy for Renal Cell Carcinoma
May/June 2008
Urologists at Penn Presbyterian Medical Center (PPMC) are
now performing robotic partial nephrectomy surgery for patients
with renal cell carcinoma. A recent addition to the expanding
robotic surgery program at Penn, robotic partial nephrectomy
surgery greatly reduces blood loss, postoperative pain and
patient recovery time when compared to standard open surgery.
Partial
nephrectomy requires a period of renal ischemia, during which
the surgeon must excise the tumor with a margin of healthy
tissue and reconstruct the remaining healthy tissue. The
technical difficulties involved in the procedure have limited
the widespread application of minimally invasive surgery
to partial nephrectomy.
Benefits
of Robotic Surgery |
Robotic
surgery has several substantial advantages over previous approaches to partial nephrectomy
surgery, including the capability to perform
rapid, more precise identification of renal
tumor boundaries and faster surgical procedures. |
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To further complement these capabilities, the latest daVinci
S robotic system at Penn adds three-dimensional high magnification
imagery, multiple simultaneous-use robotic arms and integrated
real-time intraoperative imaging.
Case Study
Mr. L, a 62-year-old man, came to the division of Urology
at PPMC for a second opinion after a local urologist recommended
open radical nephrectomy to remove a 4.0 cm solid tumor
found via CT scan on the upper pole of his right kidney.
Subsequently confirmed by MRI, the tumor was consistent
with renal cell carcinoma. At presentation, Mr. L reported
no significant past medical history. A nuclear medicine
renal scan demonstrated equal flow and function in both
kidneys. Mr. L’s baseline creatinine was slightly
elevated at 1.4 mg/dL.
Following his consultation, Mr. L was
scheduled for a robotic partial nephrectomy. Through four
small laparoscopic incisions, the tumor and a small rim
of underlying normal kidney tissue were excised, and the
defect in the kidney reconstructed. Renal ischemic time was
26 minutes.
Mr. L recovered well and was discharged
on postoperative day three. Final pathology revealed a
3.9 cm clear cell renal cell carcinoma, Fuhrman nuclear
grade 3, without evidence of invasion. The surgical margins
were negative. Following surgery, there was no discernable
change in renal function. Mr. L’s recovery was uneventful.
Three weeks after surgery he returned to work.
Our Team of Faculty
In addition to urologic care, the division of urology at
Penn Presbyterian specializes in minimally invasive laparoscopic
and robotic surgery. State-of-the-art equipment and the
clinical expertise of our faculty and staff optimize
the chance of full urologic health restoration. Our goal
is to meet the unique physical and emotional needs of
each patient in a caring, professional environment.
David
I. Lee, MD
Chief, Division of Urology, Penn Presbyterian Medical Center
Dr. Lee leads the robotic prostatectomy team at Penn.
Having performed more than 1,500 procedures in a career
that spans the history of the technology, Dr. Lee is now
among the foremost practitioners of robotic prostatectomy
in the world. In addition to surgery, Dr. Lee lectures
widely, and has published over 100 articles, abstracts
and book chapters in the field of minimally invasive urology.
C. William Schwab II, MD
Assistant Professor of Surgery,
Division of Urology
Currently among the few surgeons with
fellowship training in robotic
urologic surgery, Dr. Schwab specializes in minimally invasive
surgery for kidney
and prostate cancer, including robotic prostatectomy and
partial nephrectomy
surgery, as well as cryotherapy. Dr. Schwab has published
numerous clinical
articles and chapters on urology and prostatectomy, and
presented the findings of
his recent research at the 2007 American Urological Association
national meeting.
Access
Patient appointments are available at:
Penn Presbyterian Medical Center
240 Medical Office Building, 2nd Floor
38th and Market Streets
Philadelphia, PA 19104
To refer a patient and/or consult with
a doctor call 800-789-PENN (7366) or you can also refer
a patient online.
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