Can a partial nephrectomy be done robotically?

suki1724

Ok, I finally sat down with Dr. Dalton at Northwestern.  He first showed me my MRI images.  The mass in my kidney is basically taking up the upper left half of my kidney and he said that the Bosniak classification is a "solid 2F", he said the irregular shape is what is giving the radiologists pause.  There are septations, but no enhancement.  He said that he'd like me to see his colleague Dr. Eggener at University of Chicago, because the two of them collaborate on challenging cases. 

He said if he were to remove it, he would have to take 1/2 of my kidney and that he couldn't do it robotically, and it would be a large incision and basically a big surgery and recovery.  He also said if I were his wife, he would have me wait and watch it, and he said we could do another MRI with contrast in 3 months.  

He also said the mass is inside of my kidney, which makes the operation more difficult.  

I'm thinking I need to see a surgeon that just exclusively does kidney surgery, because if this can be done robotically, that would be what I would want. He said right now there's about a 7% chance of malignancy, which would go up dramatically if I progress to a Bosniak 3.  This started out as a Bosniak 2 cyst about 2 years ago. 

Can 1/2 of a kidney be removed robotically?  Has anyone had it done?  I'm willing to travel and would love some names of surgeons if anyone has any recommendations.  My gut instinct is telling me that it needs to come out sooner rather than later. 

 

 

 

 

 

icemantoo

Even if

suki,

 

There were no robots or partials when I was nephed 15 years ago. That being said even if you find a surgeon to do this difficult surgery as a partial robotically it could turn into a full and open neph. as a game time decision. Partials are much more difficult than a full neph.  Get a second opinion and go with the surgeon you are most comfortable with.

 

 

Icemantoo

Hd67xlch

I dont know what ...........

Im talking about most of the time, but if its already invaded half of your kidney its going to have to come out sooner or later and if you wait they may not be able to save half your kidney. When I had gotten all of my tests done and saw the Urologist/Surgeon on a Friday morning  back in 2011, I was given the choice of scheduling surgery in a month or going in Monday at 6am due to someone else cancelling, I went in Monday and got it over with. Like Ice said they may start on the robot then change course half way into it, that happened on one of my rcc lung surgeries in 2016. Surgeons really never know till they open you up and actaully get in there and see whats going on, JMO. Remember you can over think these things and drive yourself crazy in the process.Good luck.

APny

"He said right now there's

"He said right now there's about a 7% chance of malignancy, which would go up dramatically if I progress to a Bosniak 3."

I would not take that chance by waiting. Why wait to see if it progresses to a 3 which would increase the chance of malignancy dramatically? I would go find a second opinion and then make a decision. And yes, definitely find a surgeon who specializes in nephrectomies.

hardo718

My 2 cents worth

To me it doesn't make sense to leave a mass and take the "wait & see" approach.  Is it going to shrink of it's own volition?  My unprofessional opinion, NO!  As far as I'm concerned, if it doesn't belong there it needs to go like a delinquent tenant.  Personally, I had a partial neph via robotics.  I would opt for that procedure, if it's at all possible.  There are certain things that can prevent that type of surgery from being performed.  My doctor is a urologic oncologist and specialized in robotic surgery.  Unfortunately he has since left the Chicagoland suburbs and relocated to the Denver area. Miss him terribly for my follow-ups.

Best wishes,

Donna~

suki1724

Thanks for all the input!

The Dr. Eggener that Dr. Dalton wants me to see specializes in prostate surgery, so I don't think I'm even going to bother.  I'm now searching for doctors that just do kidneys only, and can remove this thing with a laparascope or Da Vinci robotic surgery.  I had my appendix out many years ago and it was an "open" surgery and it was really painful and a long recovery,(and I was young and healthy then!) I had a Da Vinci hysterectomy in 2006, and it was SO much easier on my body, and a very easy recovery, so I really want to see someone that is an expert with robotic or minimally invasive kidney surgery. I wish there was someone near Chicago, but I think I'm going to have to travel, which is fine. 

APny

I had mine at Sloan Kettering

I had mine at Sloan Kettering and Dr. Russo specializes in nephrectomy, and pioneered opting for partial neph whenever possible. He's phenomenal. He discussed with me why open is preferable to lap/robotic and convinced me. However, there are several in his department that would do it robotically if possible. Since you're willing to travel why not look into Sloan? If you google it all the surgeons come up and you can see the ones that do lap/robotic. I think I already posted to your other thread that while mine was open, it was not at all as bad as I had feared. Home on the third day and doing work at my computer on the fourth.  So if it has to be open it won't be horrible. I don't think you can compare other open surgeries to kidney. My husband had a bowel resection surgery for diverticulitis and his recovery was awful. Which is what I feared for mine, based on his. Nothing like it.

Psea103

Robotic Surgery

I had,last Monday, a Partial nephrectomy with Davinci robotics. I was home the next day. Been recovering well so far. Minimally invasive. Incredible how little pain I feel. Mostly Tylenol for pain control. Walking everyday and improving each day. Great urologist here in Syracuse, NY.  I can't say enough how well the procedure has gone for me this far. My surgeon said that they wouldn't know which system, open or robotics, partial or full removal, until they started surgery. 

It went better than I expected. Not to be feared at all. Anxiety is the worst part of this thing. 

foxhd

First of all,

The tumor has to go soon. Not in 3 months or so. Your doctor obviously feels incapable doing the procedure but is willing to let your prognosis suffer. In 3 months he still won't be able to remove it. Then what? Find a real kidney specialist tomorrow. Secondly, do you know you mght die? Isn't that why you will get another opinion?  If they need to split your carcass from knee to elbow, let them. Insisting on robotic is foolish. So what if your scar is bigger. Who is going to judge you? My incision is about 9" from sternum toward hip. I was back to training, golf, motorcycling, with even and balanced defined abs in a month. Few who get robotic exceed that. You will need a few weeks recovery at minimum anyway.  Let the surgeon decide the most effective procedure to save your life.  I think your priorities are mixed. You are more concerned with the surgical technique than the outcome.

Sorry to come down on you like this. I have followed hundreds of newbies in 6 years. I have been through the mill and back several times. If you joined this forum for the advice of experience, I give you mine. Please know I care. Just get it done right. Good luck with your choices.

suki1724

Yep, I do know I might die, thanks

I also have had heart surgery and lung issues, SO the easiest surgery for my body is what needs to happen or the surgery that might have been not big deal for someone else could kill me. It's absolutely not about the scar, I could care less about that.  So I'm doing the best I can right now to make sure I'm around as long as I can be for my kids. I'm not here for this, so taking a break from this space, which I came to for advice and support. Congratulations on making your point. Wishing you much health and wellness. 

Positive_Mental_Attitude

suki1724 said:

Yep, I do know I might die, thanks

I also have had heart surgery and lung issues, SO the easiest surgery for my body is what needs to happen or the surgery that might have been not big deal for someone else could kill me. It's absolutely not about the scar, I could care less about that.  So I'm doing the best I can right now to make sure I'm around as long as I can be for my kids. I'm not here for this, so taking a break from this space, which I came to for advice and support. Congratulations on making your point. Wishing you much health and wellness. 

Sorry for your dismay.  You

Sorry for your dismay.  You have a trying set of circumstances.  FoxHD can be blunt, but please understand he was trying to help.  I went to the same place and doctor (Dr. Russo) as APNy.    Prior to my surgery, I had what my doctors termed a "hostile abdomen."   I had surgery as a newborn for blocked intestines.  My doctors actually advised against robotic or laparascopic surgery.  I was quite concerned about more and larger scars on my abdomen, not from a cosmetic standpoint, but because of issues that I have had with digestion and scar tissue.  Anyway, Dr. Russo was magnificent.  Surgery on Thursday morning, and I went home on Saturday.  By Monday, I was walking 4 miles per day.  I don't want to give you the impression that it was a breeze--Friday, Saturday and Sunday were uncomfortable.  But I think an open surgery in the hands of an extremely skileld and experienced surgeon like Dr. Russo is not so bad.

One other thing, after reading your original post.  You said, "He also said the mass is inside of my kidney, which makes the operation more difficult."  This may dictate an open surgery over lap/robotic.  I had a small tumor, but it was in difficult location--I forgot the exact terminology.  The first doctor I saw told me they would have to take my entire kidney because of the location.  When I saw Dr. Russo for the first time, he explained to me that his experience in doing OPEN nephrectomies was that he would have a better chance of saving more of my kidney by doing an open surgery versus robotic/lap.  

Hope this helps.

Good luck!!!

Positive_Mental_Attitude

One more thing. I found

One more thing. I found Doctor Russo by reviewing the American Urological Association Guideline for Management
of the Clinical Stage 1 Renal Mass.  Dr. Russo was on the panel that authored the document.

Other dcotrs on the panel that may be worth considering:

Steven C. Campbell, MD, PhD, Cleveland Clinic

Jihad H. Kaouk, MD, Cleveland Clinic

George Kuoche Chow, MD, Mayo Clinic

Jason Perani

I had it done

I had my partial  done robotically last Novemebr 16. My Cancer was almost at 1/2 of my kidney. My surgery was doen my Dr Adam Clemeons at Mount Carmel health system in Columbus, Ohio. Dr Clemons Worked at the Mayo Clinic Prior to coming to Columbus. He told me that my tumor was one of the hardest he had ever had to try and get out. It was lodged between 2 blood vessels. I wanted it out as soon as I foudn out is was there. If i were you I would call around and get a second opinion. If Columbus Ohio is not too far Dr Clemons is Awsome.

hardo718

Naperville Illinois close enough?

I now see Dr. Amit Patel for follow-ups and he specializes urology / oncology and uses the Da Vinci robot.  My surgeon was his associate at the time (almost 5 years ago) Dr. Mark Fisher but he has since relocated to Colorado.

Best Wishes,

Donna~

Jan4you

Hey there Suki, sorry for

Hey there Suki, sorry for what you are going through. Agree with the others, get another opinion from surgeon familiar with kidney cancer, robotic/laproscopic/open type surgeries. 

I am sorry for how Fox how he said what he did. That was harsh and cruel in my opinion.

Please stay. I sent you an email. Look for it under upper left hand box under CSN Email. You should also get an email letting you know you have a private message on here.

Sending you HOPE, better information and the best surgeon for your situation!

Hugs, Jan

Champers

You got this Suki

Whatever you choose, it will be right for your own circumstances. You are listening to the surgeons. You know when one is not comfortable with a given procedure. The true professionals will send you to the right expert if they are inexperienced or unsure of their competence with any given procedure. 

My situation was watch and wait, and during that time I found the surgeon with the most experience in partial robotic nephrectomies (he also happens to be a pioneer in prostate surgeries, not a disqualifier for me). The procedure was perfect for my life: very fast recovery so I could get back to my life as soon as possible. Please read my profile for more info, and best wishes for the speediest recovery!

hardo718

Champers said:

You got this Suki

Whatever you choose, it will be right for your own circumstances. You are listening to the surgeons. You know when one is not comfortable with a given procedure. The true professionals will send you to the right expert if they are inexperienced or unsure of their competence with any given procedure. 

My situation was watch and wait, and during that time I found the surgeon with the most experience in partial robotic nephrectomies (he also happens to be a pioneer in prostate surgeries, not a disqualifier for me). The procedure was perfect for my life: very fast recovery so I could get back to my life as soon as possible. Please read my profile for more info, and best wishes for the speediest recovery!

Off topic but

Yummy dog Champers!!!   SOOOOOOO cute!

Donna~