First robotic surgeries on kidney cancer patients

A team led by an Indian-origin surgeon has successfully performed robotic surgeries on kidney cancer patients, using only seven small incisions and four robotic tools.
Surgery is required when cancer of the kidney causes a Level III thrombus, or clot, to develop in the major vein leading back to the heart.
Traditionally this procedure, known as inferior vena cava (IVC) thrombectomy, is performed using a large open incision, primarily because the vein is often difficult to reach.
In a new study, the surgeons reported the first cases in which this procedure had been successfully performed robotically, using only seven small incisions and four robotic tools.

"Level III IVC tumour thrombectomy for renal cancer is one of the most challenging open urologic oncologic surgeries," said Inderbir S Gill, of the University of Southern California Institute of Urology in US.
"While IVC tumour thrombus occurs in only 4-10 per cent of all patients with otherwise organ-confined kidney cancer, surgery is the only cure. The ability to do this complicated procedure in a minimally invasive way represents a major advancement," Gill said.

The authors reported on nine patients with renal cancer and Level III thrombi treated with robotic IVC thrombectomy.
After about seven months of follow-up, all have survived and eight showed no evidence of disease. One patient had a spinal tumour and has since undergone further surgery.

The study also details seven additional robotic surgeries on patients with smaller thrombi (Level II), and compares tumour sizes, operating room times, blood losses, length of hospital stays, and other details for Level III and Level II cases.
"All necessary surgical manoeuvres could be performed completely robotically without open conversion or mortality," the researchers said.
"This demonstration of efficient robotic performance of the challenging vascular, oncologic and reconstructive procedures inherent herein opens the door for major renal, caval, and hepatic robotic surgeries in the future," they said.
The study was published in The Journal of Urology.