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two large complex cysts just discovered

Terry44
Posts: 3
Joined: Dec 2010

At thanksgiving I found that I have a Bosniak Type II cyst (4cm X 3.5cm) on the upper pole of my right kidney and a much larger Bosniak Type IIF 8.0cm X 6.0 cm complex cyst on the mid pole of the same right kidney. I also hava a smaller Type I (1.5 X 2.0) cyst at the bottom of the right kidney. There are no cysts on my left kidney. I have no symptoms. These were found during an ultra sound for another reason.

My local urologist told me he could only take out the entire kidney and told me to go to the Cleveland Clinic in Cleveland OH to see Dr. Kaouk who specializes in robotic partial nephrectomy. I went to Cleveland in early December to see Dr. Kaouk. He told me I had two options; watchful waiting or go in for surgery. I told him I was concerned about the large size of the two complex cysts. I asked him what he would do if it was his kidney and he told me he would operate. So I am scheduled for early February to do a robotic partial nephrectomy of my right kidney.

Anyone else have situations like this? Am I doing the right thing?

Terry

blackbelt's picture
blackbelt
Posts: 32
Joined: Apr 2006

Hey Terry44 I am not a doctor, I would like to share the advice my Veterans Administration Urologist doctor told me on my choice of surgery, he recommended the Open partial nephrectomy verus Laparoscopic partial nephrectomy , yes you will have a big scar, yes it will take a lttle longer to heal, he said having the Laparoscopic partial nephrectomy there may be a risk they could not remove all of your cyst/mass, A "positive margin" means that some of the kidney cancer may have been left on the kidney, he would rather be able to feel & see the cyst/mass rather than just looking through a scope.

Another type of surgery is DaVinci® robotic laparoscopic partial nephrectomy DaVinci® robotic system which incorporates the DaVinci® robotic system to assist the surgeon to perform a laparoscopic partial nephrectomy. As DaVinci® robotic laparoscopic partial nephrectomy is a very technically challenging operation, it is not offered at many centers.

A disadvantage of the procedure is that only few doctors offer this procedure to their patients. Additinally, the application of the robot in the setting of laparoscopic partial nephrectomy is new and comparison to other treatment modalities is just beginning. Overall, the robotic technology seems to be a wonderful adjunct to an experienced surgeon who is familiar with kidney cancer as a disease and laparoscopic anatomy and technique.

Robotic laparoscopic partial nephrectomy with the DaVinci® robotic system uses the robot and a minimally invasive approach (laparoscopy) to perform exactly the same procedure that is done in open or laparoscopic partial nephrectomy. In any partial nephrectomy (open, laparoscopic, or robotic), the kidney cancer is removed with a small amount of normal tissue around it. The normal tissue around the cancer that is removed is known as the margin, and this tissue serves to assure that no cancer is left in the body. The term "negative margin" means that the entire kidney cancer has been removed completely.

A "positive margin" means that some of the kidney cancer may have been left on the kidney. With the robotic laparoscopic procedure, just as in the standard laparoscopic approach to partial nephrectomy, no large incisions are required to perform the procedure. Instead of a large incision, five or six 1/2 cm to 1 cm incisions (less than 1/2 inch) are made. The spaces in the body are gently filled with gas to make working space and a small camera is placed into the body through one of the incisions. The other small incisions are used to place working instruments, which can be used to perform the procedure.

Do your research, ask the right QUESTIONS, depending on the size/location/ of your mass/tumor/abnormality will be a factor in the decision you and your doctor will make, be very careful if your doctor will not offer a open partial nephrectomy because your doctor might be trying to save money for your healthcare insurance company, I was really blessed to have the best oncology doctor through the The VA.

Another question for your doctor is if they had kidney cancer what type of surgery would they have WITH THE BEST NEGITIVE MARGIN RESULT, YES YOUR DOING THE RIGHT THING KEEP ASKING QUESTIONS, go on living a long life, any questions please contact me.
GOD BLESS

icemantoo's picture
icemantoo
Posts: 1456
Joined: Jan 2010

I did a Google search of Terry44's surgeon at Cleveland Clinic and although very young his credentials are very impressive. In talking to another urologist the ones doing these procedures are those specially trained at a handful of programs in the best hospitals and Universities and most of these new procedures have evolved in the last 10 or 15 years. Older doctors have been doing these nepherectomys for years and it is for the most part only the younger ones who are doing the laproscopic. partial and robotic procedures. Obviously for some tumors an open nepherectomy is necessary. This is not to suggest that there is anything wrong with the oncologists and surgeons at the VA, only they may not be in the forefront of these newly developing procedures.

blackbelt's picture
blackbelt
Posts: 32
Joined: Apr 2006

No disrespect ICEMANTOO I know you're just trying to help others with information about kidney cancer, it's obvious you do not know very much about the Veterans Administration, when you're talking about cancer treatment they offer state-of-the-art cancer treatment, my urology Dr. was a young doctor finishing his residency at one of the best VA teaching hospitals in the world. The VA first offered me the option to have laparoscopic or robotic partial nephrectomy, but my urology Dr. then suggested because of the location of my abnormality he suggested/recommended a Open partial nephrectomy and then went on to explain the advantages/disadvantages versus laparoscopic or robotic partial nephrectomy. I then asked my urology Dr. if you were my age and because of the location of my abnormality what type of surgery would you personally request and then he went on to explain about positive versus negative margin and suggested/recommended a Open partial nephrectomy.So then it was my time to go back home and do my research not just do a simple Google search. I was just like everybody else about being told I might have possible kidney cancer, scared and very ignorant about how to fight kidney cancer, Yes ICEMANTOO I would like to personally thank you for caring/sharing and helping others with kidney cancer information.

icemantoo's picture
icemantoo
Posts: 1456
Joined: Jan 2010

Blackbelt.

I appreciate your well thought out response. I guess each of us who are faced with these difficult decissions will make them not from what you or I went through, but from an informed discussion with their doctor talking about their diagnosis and not anyone elses.

Best regards Icemantoo

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