Robotic trained surgeons at Fox Chase Cancer Center in Philadelphia presented the new and novel approach to surgically treat urothelial cancer - in the lining of the bladder or kidney - at the American Urological Association's Annual Meeting. Using da Vinci robot-assisted technology, urologic cancer surgeons perform complicated urologic cases using minimally invasive surgery.
Standard treatment for ureteral cancer is surgical resection of the tumour, called a distal ureterectomy, or removal of the entire kidney, called a nephro-ureterectomy. Depending on the experience of the surgeon, this procedure can be performed using open surgery, while others may elect a laparoscopic approach. In either instance, the surgeon's experience is vital for preserving function of the kidney.
"A minimally invasive approach to this procedure is challenging for even the most experienced laparoscopist. This is due to the technical challenge of re-implanting the ureter into the bladder", stated Rosalia Viterbo, MD, robotic surgeon at Fox Chase and co-author on the study. "Robotic assistance can make a minimally invasive approach more technically feasible."
In a conference video abstract, Fox Chase urologic cancer surgeons, Rosalia Viterbo and her colleague David Y.T. Chen, MD, demonstrated the four-arm technique for robot assisted distal ureterectomy. Rosalia Viterbo is shown performing the robotic distal ureterectomy on a 73-year-old man with a distal left ureteral tumour. She explained: "The patient presented with stage 3 chronic kidney disease, so a nephron-sparing approach was taken to preserve kidney function. During the surgery, the four robotic arms and two assistant ports were successfully positioned in a manner similar to robot assisted radical prostatectomy."
This approach resulted in the usual benefits associated with minimally invasive surgeries, such as less bleeding and scarring, shorter hospital stay, faster recovery and return to normal activity and with his kidney function preserved.
Experienced laparoscopic surgeons at high volume centres, such as Fox Chase, are now using the da Vinci robot assisted surgical system for patients with kidney cancer, or renal cell carcinoma. The advanced technology has enabled faster and greater technical proficiency allowing for completion of complex surgical procedures, facilitating a minimally invasive approach for partial nephrectomy.
"Our patients have experienced many benefits from the robot assisted approach, including shorter hospital stays - average 3 days, preserved kidney function with reduced need for dialysis, smaller scars with optimal cosmetic results, lower blood loss and easier and earlier return to normal activity", stated Rosalia Viterbo.
As a result of the fast recovery, patients do not delay the next step in their treatment plan, chemotherapy or radiation therapy, stopping the disease from progressing as fast. Similarly, patients with disease on both kidneys benefit because there is less waiting time between surgeries and there is no delay on further treatment. Again, this provides less opportunity for the cancer to grow and spread.
William Krassan came to Fox Chase after learning he had renal cell carcinoma in the right kidney and cystic renal cell carcinoma in the left. Using the da Vinci robot, Rosalia Viterbo performed a partial nephrectomy on each kidney, just 8 weeks apart. This laparoscopic approach allowed the surgeon to reach the kidney through 4 tiny holes in the patient's abdomen. Open surgery would have required one large incision in his back and a longer time until the next surgery could have occurred.
"The procedure and recovery were fairly painless and easy", stated William Krassan. "Dr. Viterbo did a wonderful job in an expeditious way. She was able to save 90 percent of my right kidney and two-thirds of my left kidney." Dr. Viterbo added: "Results of the study show robot assisted partial nephrectomy to be a safe and technically feasible minimally invasive approach to kidney sparing surgery."
Fox Chase Cancer Center is one of the leading cancer research and treatments centres in the United States. Founded in 1904 in Philadelphia as one of the United States first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programmes in cancer prevention, detection, survivorship, and community outreach.