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Considering having Laparoscopic partial nephrectomy/DaVinci® robotic laparoscopic partial versus Open partial nephrectomy?

blackbelt's picture
Posts: 32
Joined: Apr 2006

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 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.

I had a open partial nephrectomy on 5/17/2006 at the age of 51, renal cell carcinoma, clear cell type, Fuhrman grade 2, stage I, 1.2 cm right renal mass, with complications, doctors nicked right lung and nicked lower abdominal peritoneum area, this kind of surgery was high risk high return because of location of kidney tumor!

Ask your doctor if they had kidney cancer what type of surgery would they have, quit worrying, go on living a long life, any questions please contact me.

bluerose's picture
Posts: 1112
Joined: Jul 2009

Yesterday I was flipping tv channels and came upon the Dr. Oz show, which I hardly ever watch, but they had a good show on gynecological issues. One of the segments had on it some good advice given by a specialist on what to ask your doctors and HOW.

When trying to make a decision on which way to go with surgeries or medications that are offered to a patient as options the specialist said to ask 'what would YOU choose if I was you?' She said that with that question specifically they often change their focus and will start to discuss the options in a more personal and honest way. I thought that was very interesting.

Just threw in my 2 cents to this discussion. Hope it helps a little. Blessings, Bluerose

Posts: 10
Joined: Aug 2010

We went to three different surgeons before making a decision and only the ones who were skilled in the robot assisted laparoscopic partial nephrectomy offered it as an option. Another surgeon we went to wanted to do an open surgery with a rib removal. He was an older doctor who was not as up to date in the newest procedures. We found a doctor who specializes in the laparoscopic partial nephrectomy who has done hundreds of them. I highly doubt he offered it as an option to us so he could save the insurance company some money. It was in no way a cheap surgery. Some surgeons are skilled in different things and you have to find one that is a right fit for you that you are comfortable with.

I am not sure why you keep posting the same things in several different threads but I will say that it has been frustrating lately to come and read the boards and the same things are posted in several threads by you.

Posts: 22
Joined: May 2011

I know your post is from a year ago, but was still wondering weher you had your surgery and for what size tumor. Thanks

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