Laparoscopic Surgery for Treating Kidney Cancer

What is Laparoscopic Surgery for Kidney Cancer?

The surgery currently recommended consists of removing the whole kidney (radical nephrectomy) or the tumour and surrounding tissue (partial nephrectomy or tumorectomy) by keyhole surgery – i.e. without the incision used in “open” surgery. Wherever possible, a partial nephrectomy is preferred to maintain renal function.

Use of this method always depends on the stage and patient’s performance status.

As it is minimally invasive, keyhole surgery provides a less painful and quicker recovery with shorter hospitalisation and far less blood loss, allowing patients to return to normal life much sooner than classical surgery.

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What is the Procedure?

Laparoscopic surgery for kidney tumours, like all keyhole surgery, involves making small millimetre-sized incisions in the patient’s abdomen to insert the surgical instruments.

One of these instruments is a laparoscope with a video camera which films the patient’s inner abdominal cavity. This allows the surgeon to operate via a TV screen.

The kidney is fully removed (or partly in the case of partial nephrectomy) via an incision which is widened so the organ (or part of it) can be extracted.

This type of surgery may not be feasible for removal of very big tumours that invade the tissue around the kidney or the venous structures, like the inferior vena cava.

It is now possible to perform this type of surgical procedure with a robotic aid, providing more precise operation of the instruments. However, in radical nephrectomy, robotic aids do not make a significant contribution. In partial nephrectomy, they can make surgery simpler, but they are not essential, unlike other situations.

Laparoscopic Radical Nephrectomy

Radical surgery was popularised by Robson in 1969 and consists of removing the total kidney, Gerota’s fascia and perirenal fat (enveloping the kidney), suprarenal gland and lymph glands of the “renal hilum” (beside the renal artery and renal vein).

It is used for large lesions or those for which partial surgery is not feasible, and in patients with metastatic disease and good performance status.

Laparoscopic Partial Nephrectomy

This surgery is considered the gold standard for small lesions and involves the total removal of the renal lesion and adjacent tissue while preserving the remaining renal parenchyma.

The indications for performing this procedure can be:

Absolute – in the event of a single kidney or a bilateral neoplasm;
Relative – presence of a pathology that affects renal function;
Elective – small lesions (T1a) and a normal contralateral kidney.

In elective uses, the rates of recurrence and survival are similar to radical nephrectomy.

When partial keyhole surgery is performed, a vascular clamp is normally used on the blood vessels that irrigate the kidney, minimising loss of blood and facilitating the procedure.

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What is the Post-Treatment?

Patients who undergo surgery (both radical and partial nephrectomy) are provided with regular medical follow-up.

Medical assessment is provided for a period of at least 5 years. During this time, various diagnostic tests are requested to establish whether there has been a recurrence of the tumour and, if so, to detect it as quickly as possible.

The most usual tests requested during follow-up are CT scans of the thoracic, abdominal and pelvic areas (in addition to equally regular blood and urine tests). This can be alternated with abdominal ultrasounds and thorax x-rays to limit the amount of patients’ radiation exposure.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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