Laparoscopic nephrectomy is the video telescopic approach to total removal of the kidney using a few portholes. The kidney and its tumor are removed through a small incision about the navel. Often, this procedure is done with a hand in the abdomen, called hand-assisted laparoscopic nephrectomy.
The virtues of laparoscopic nephrectomy over open nephrectomy are multiple:
- Equivalent cancer control
- Less blood loss
- Less pain
- Shorter hospital stay (1 or 2 days)
- Fewer wound infections
- Smaller scars
- Quicker return to activities of daily living (2-4 weeks instead of 6-8)
- Quicker overall convalescence (2 months instead of 6)
For those who qualify for the laparoscopic approach, there is essentially no downside. However, given that there is no reconstructive component to this surgery, robotics adds virtually nothing to the safety or recovery profile of laparoscopic nephrectomy. It is possibly useful for surgeons without much training in laparoscopic techniques. Dr. Kaynan routinely performs laparoscopic nephrectomy within 2 hours, and as fast as 31 minutes. In his experience, except for possibly the morbidly obese patient, robotics adds only operative time and expense. With the advent of the Xi daVinci platform, however, Dr. Kaynan is examining the utility of using robotics for total nephroureterectomy in patients with transitional cell carcinoma of the kidney.