Robotic-Assisted Kidney and Urology Reconstructive Surgery

Robotic-Assisted Kidney and Urology Reconstructive Surgery

Robotic-Assisted Kidney and Urology Reconstructive Surgery

The kidneys are two bean-shaped organs in the renal system. They help the body pass waste as urine. They also help to filter blood before sending it back to the heart. Each kidney is attached to a ureter, a tube that carries excreted urine to the bladder.

The kidneys perform many crucial functions, including:

  • Maintaining overall fluid balance
  • Regulating and filtering minerals from blood
  • Filtering waste materials from food, medications, and toxic substances
  • Creating hormones that help produce red blood cells, promote bone health, and regulate blood pressure
Robotic-Assisted Kidney and Urology Reconstructive Surgery

KIDNEY CANCER

Kidney cancer is one of the more common cancers that affect the urinary system, with an incidence rate of 1.6 per 100,000 in the Malaysian population according to the 2012 Globocan statistics. More than 80% of all kidney cancers are renal cell carcinoma (RCC), and it occurs in a male-to-female ratio of 2:1. Classic symptoms include flank pain, a palpable abdominal mass and gross hematuria (blood in the urine) or anemia. About 95% of all solid tumours larger than 2.0 cm are cancerous, while benign growths in the kidneys are rare.

Kidney
Kidney

Kidney cancer is relatively resistant to non-invasive treatments such as radiation and chemotherapy. Due to this reason, the gold standard treatment for localised kidney cancer is surgery.

Surgery to remove the whole kidney is known as a radical nephrectomy. When only a tumour is removed, leaving the healthy portion of your kidney intact, it is called a partial nephrectomy.

Stage 1
Tumor is found only in the kidney and 7cm at its largest area.
Stage 2
The tumor is only in the kidney and is more than 7 cm but not more than 10cm at its largest.
Stage 3
The tumor has spread to the vena cava above the diaphragm and into the right atrium of the heart or to the walls of the vena cava.
Stage 4
The tumor has spread to areas beyond Gerota’s fascia and extends into the adrenal gland on the same side of the body as the tumor.

Urologic Reconstructive Surgery

Kidney reconstruction is a surgical procedure used to repair congenital or acquired problems in the kidney and the ureter, such as blockages/ fistulae, following kidney tumour resection, or due to kidney injury from trauma.

Pyeloplasty Surgery

Pyeloplasty Surgery

This reconstructive surgical procedure corrects an abnormality known as a ureteropelvic junction (UPJ) obstruction, which occurs when there is a blockage, narrowing or scarring of where the renal pelvis connects with the ureter (the tube that drains urine from the kidney to the bladder). The goal is to remove the blockage, allowing urine to drain freely from the kidney to the bladder.

Vesicovaginal Fistulae (VVF) Reconstructive Surgery

Vesicovaginal Fistulae (VVF) Reconstructive Surgery

Vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and the vagina, leading to the continuous, involuntary discharge of urine into the vaginal vault. The primary causes of this condition include:

  • Obstructed labour (obstetric fistula), which occurs when prolonged labour presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. This results in tissue necrosis (death), leaving a hole.
  • Violent cases of sexual trauma and foreign body insertion.
  • Surgical trauma resulting from gynecologic procedures (e.g., hysterectomy, cancer operations, radiation-induced fistula, or cone biopsy)
Vesicovaginal Fistulae (VVF) Reconstructive Surgery

Ureteral Reimplantation Surgery

Ureteral reimplantation surgery involves detaching and rejoining the ureter from its abnormal position to the bladder. Ureters are the tubes that carry urine from the kidneys to the bladder. Normally, the ureter enters the bladder at an angle, forming a tunnel that compresses when the bladder is full. This prevents urine from flowing back up into the kidney, a condition known as vesicoureteral reflux. Vesicoureteral reflux can damage healthy kidney tissue, potentially leaving the patient with end-stage renal disease.

Common signs of this condition in adults include urinary tract infections, elevated blood pressure, protein found in the urine and hydronephrosis.

Most patients also experience fever, abdominal or flank pain and urinary retention to circumvent the burning sensation caused by UTIs. Pediatric patients make this condition even more difficult to diagnose; non-specific symptoms can include diarrhoea, loss of appetite, irritability and an unexplained fever. High blood pressure also may be present due to chronic kidney disease. The type of hypotension observed in these cases is known as secondary hypotension, which is primarily caused by kidney disease. Due to the amount of reflux, the adrenal glands secrete excessive amounts of hormones and cause hypotension.

Urologic Reconstructive Surgery

Kidney reconstruction is a surgical procedure used to repair congenital or acquired problems in the kidney and the ureter, such as blockages/ fistulae, following kidney tumour resection, or due to kidney injury from trauma.

Pyeloplasty Surgery

Pyeloplasty Surgery

This reconstructive surgical procedure corrects an abnormality known as a ureteropelvic junction (UPJ) obstruction, which occurs when there is a blockage, narrowing or scarring of where the renal pelvis connects with the ureter (the tube that drains urine from the kidney to the bladder). The goal is to remove the blockage, allowing urine to drain freely from the kidney to the bladder.

Vesicovaginal Fistulae (VVF) Reconstructive Surgery

Vesicovaginal Fistulae (VVF) Reconstructive Surgery

Vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and the vagina, leading to the continuous, involuntary discharge of urine into the vaginal vault. The primary causes of this condition include:

  • Obstructed labour (obstetric fistula), which occurs when prolonged labour presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. This results in tissue necrosis (death), leaving a hole.
  • Violent cases of sexual trauma and foreign body insertion.
  • Surgical trauma resulting from gynecologic procedures (e.g., hysterectomy, cancer operations, radiation-induced fistula, or cone biopsy)
Vesicovaginal Fistulae (VVF) Reconstructive Surgery

Ureteral Reimplantation Surgery

Ureteral reimplantation surgery involves detaching and rejoining the ureter from its abnormal position to the bladder. Ureters are the tubes that carry urine from the kidneys to the bladder. Normally, the ureter enters the bladder at an angle, forming a tunnel that compresses when the bladder is full. This prevents urine from flowing back up into the kidney, a condition known as vesicoureteral reflux. Vesicoureteral reflux can damage healthy kidney tissue, potentially leaving the patient with end-stage renal disease.

Common signs of this condition in adults include urinary tract infections, elevated blood pressure, protein found in the urine and hydronephrosis.

Most patients also experience fever, abdominal or flank pain and urinary retention to circumvent the burning sensation caused by UTIs. Pediatric patients make this condition even more difficult to diagnose; non-specific symptoms can include diarrhoea, loss of appetite, irritability and an unexplained fever. High blood pressure also may be present due to chronic kidney disease. The type of hypotension observed in these cases is known as secondary hypotension, which is primarily caused by kidney disease. Due to the amount of reflux, the adrenal glands secrete excessive amounts of hormones and cause hypotension.

Kidney and Urology Reconstructive Surgery

Surgery can be performed with open surgery or minimally invasive surgery (laparoscopy).

Kidney and Urology Reconstructive Surgery

Open Surgery

Surgery is performed through one large incision (cut) which allows doctors to touch your organs as they operate. The exact size of the incision will depend on the type of procedure being performed.

Minimally-invasive Surgery

During minimally invasive surgery (also known as laparoscopy), the surgeon stands beside the patient and operates through a few small incisions using long, straight instruments and a tiny camera. The camera provides a magnified view inside the patient's body and sends 2D images to a video monitor in the operating room, guiding doctors as they operate.

Robotic-assisted Surgery

Another minimally invasive surgical option is da Vinci Robotic Surgery. The surgeon sits at a nearby console to control the robot. The system translates all of their hand movements into precise movements of tiny instruments which can bend and rotate inside the patient’s body. The surgeon views the 3D display which provides a magnified view inside the patient's body.

Q:

How long does a robotic-assisted kidney and urologic reconstructive surgery take?

A:

The surgery may take 2 to 3 hours depending on the patient's anatomy and the extent of surgery which may take longer time.

Q:

How long will I have to stay in the hospital after surgery, and when can I resume normal activities?

A:

Most patients typically require a hospital stay of 2 to 3 days and can usually resume normal activities within 2 weeks after surgery.

Q:

What are the potential benefits of robotic-assisted kidney and urologic reconstructive surgery?

A:

da Vinci Partial Nephrectomy offers the following potential benefits to patients:

  • Shorter hospital stay
  • Less pain
  • Less blood loss
  • Fewer complications
  • Smaller incisions for less scarring
  • Shorter warm ischemic time (shorter is better for kidney function)
  • Fewer complications
  • Similar positive surgical margin rates
  • Better renal (kidney) function rate

Also, studies have shown that patients who have kidney-sparing surgery (partial nephrectomy) are less likely to suffer from chronic kidney disease (CKD) or need dialysis compared to patients who lose their entire kidney.

Q:

What are the risks and considerations related to kidney and urologic reconstructive surgery?

A:

Serious complications may occur in any surgery, including da Vinci® Surgery. Risks and considerations related to kidney surgery include poor kidney function often due to limited blood flow, leaking of urine, cut or tear in the spleen, pancreas or liver, bowel injury, trapped air between the chest wall and lung, injury to diaphragm (muscle separating the chest from the abdomen), urinary fistula (abnormal bond of an organ, intestine or vessel to another part of the body), abnormal pooling of urine, limited or cut off blood supply to kidney, abnormal pooling of lymph fluid.

Patients should talk to their doctor to decide if da Vinci Surgery is suitable for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision.

For important safety information, including surgical risks, indications, considerations and contraindications for use, please also refer to www.davincisurgery.com/safety or www.intuitivesurgical.com/safety

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