Radical nephrectomy – Da Vinci

Radical nephrectomy is a surgical procedure in which the entire kidney is removed along with the surrounding fatty tissue, and in some cases, the regional lymph nodes. This operation is a standard treatment for patients with malignant kidney tumors that affect a large portion of the organ or have spread to surrounding tissues.

Using the Da Vinci robotic system, radical nephrectomy is performed through a minimally invasive approach, allowing for more precise tissue resection, reduced surgical trauma, and faster recovery compared to traditional open surgery.

Radical nephrectomy is recommended for patients whose kidney tumor:

• Is larger than 7 cm and affects most of the kidney
• Has spread to nearby tissues or blood vessels
• Is positioned in a way that makes partial resection impossible
• Is associated with significant kidney function impairment

The decision to proceed with surgery is made following a detailed diagnostic work-up including CT or MRI imaging, laboratory tests, and consultations with a urologist and oncologist.

Prior to surgery, patients undergo a series of diagnostic tests to evaluate overall health and minimize risks. Standard evaluations include:

• Blood and urine tests
• Electrocardiogram (ECG) and cardiovascular risk assessment
• Imaging studies (CT scan, MRI, kidney ultrasound)

Patients are advised to avoid medications that increase bleeding risk, such as anticoagulants or anti-inflammatory drugs, for several days before the procedure.

Radical nephrectomy using the Da Vinci robotic system is performed through several small incisions, through which the surgeon controls highly precise robotic instruments. The procedure typically involves:

• Creating a pneumoperitoneum (inflating the abdomen with gas to create working space)
• Inserting robotic instruments through small abdominal incisions
• Carefully isolating the tumor and kidney from surrounding structures
• Sealing the renal blood vessels to prevent bleeding
• Removing the kidney through one of the incisions with minimal tissue damage

The procedure lasts between 2 to 4 hours, depending on the complexity and patient anatomy.

After surgery, the patient is monitored in the intensive care unit to track vital signs. The typical recovery includes:

• Hospital stay: 2 to 4 days
• Return to light activity: Within 2 to 3 weeks
• Full recovery: In 4 to 6 weeks

Most patients experience mild discomfort and fatigue during the first weeks, but thanks to the minimally invasive approach, pain is significantly reduced compared to open surgery.

While radical nephrectomy is generally safe, possible complications include:

• Infection and bleeding
• Injury to adjacent organs or blood vessels
• Long-term reduction in remaining kidney function

Postoperative care includes regular kidney function monitoring and adjustment of diet and fluid intake to protect the remaining kidney.