USC urologists have developed a new method of robotic surgery for kidney cancer, which could help reduce organ damage.
A world first, this novel robotic and laparoscopic technique was reported in 15 initial patients in the January issue of European Urology.
Current techniques of kidney-sparing surgery (termed partial nephrectomy) require the kidney blood flow to be stopped by clamping the renal artery while the tumor is being removed. Stopping renal blood flow negatively can affect kidney function.
USC’s novel robotic technique, called “zero-ischemia” partial nephrectomy, allows uninterrupted blood flow to the kidney during the entire operation. By removing only the tumor and saving the rest of the kidney without stopping its blood flow, kidney damage is minimized, leading to superior kidney function.
Pioneered by Inderbir S. Gill, professor, chairman and executive director of the USC Institute of Urology, this technique involves renal artery micro-dissection.
“We use delicate robotic neurosurgical aneurysm micro-bulldog(s) to control specific, pre-terminal renal artery branches, which directly supply the tumor,” Gill said. “Thus, blood supply to the rest of the kidney stays untouched.”
Gill added that meticulous anesthetic techniques for controlled reduction of blood pressure were employed as needed.
“We monitored these patients very carefully by evaluating their brain, heart and lung function intraoperatively,” said Duraiyah Thangathurai, a renowned leader in urologic anesthesia and an integral member of Gill’s team in developing this technique.
Other co-authors of the paper include Manny Eisenberg, Mukul Patil, Andre Berger, Casey Ng, Monish Aron, Mihir Desai and Vito Campese.
Thus far, the technique has been carried out successfully in the first 75 patients at USC, proving that the method is feasible. Initial data indicate that patients undergoing the new technique may have superior surgical outcomes and better kidney function.
Interest in the zero-ischemia technique is growing. In December 2010, a team led by professor Michele Gallucci from the Istituti Fisioterapici Ospitalieri in Rome visited USC to learn the technique and became the first to apply it in Europe. Gallucci’s team already has performed zero-ischemia partial nephrectomy in 25 patients.
“Gill’s technique is the best way to optimize patient outcomes,” Gallucci said. “It will change the way partial nephrectomy surgery is done.”
On March 4-5, the USC Institute of Urology will hold the first Live Surgery Robotic Symposium to demonstrate the zero-ischemia technique to a group of more than 50 national and international surgeons at the Aresty auditorium on the USC Health Sciences campus. In addition, USC urologists will be presenting five papers on this novel technique at the upcoming American Urological Association meeting in Washington, D.C., in May.
“Saving kidneys is very important for overall health and longevity,” Gill said. “This new possibility that even complex kidney tumors can be removed robotically without renal ischemia is very exciting.”
Gill recently was named the first North American editor of European Urology. The highly influential publication has been published for more than 35 years and is read by more than 20,000 urologists around the world.