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My Partial Nephrectomy Too Complex for da Vinci?

Tesla1
Posts: 46
Joined: Mar 2017

Scheduled for an OPEN left partial nephrectomy for a 4cm renal cell carcinoma in a few weeks. Really like my urologist. He is very skilled surgeon, listens to my questions and has a great bedside manor. He is telling me that he recommends that I have an open procedure instead of robotic because of the complexity of the tumor which is partly inside and outside of the kidney (mesophytic?). He stated that he has more time to excise the tumor and ensure that I have negative margins while also checking pathology of the tissue while doing the surgery. Said that cold ischemia gives him more time to be very thorough than a robotics procedure since cold ischemia is not an option for a robotic procedure. He does not do robotics procedures. I asked him would a robotics surgeon attempt this procedure and he said yes as many like a challenge. 

Anyone have any knowledge or experience with this? I would much rather have the recovery of a robotics procedure than an open but I'm more worried about long time survival than short term comfort.

Steve.Adam's picture
Steve.Adam
Posts: 460
Joined: Oct 2016

My inclination would be to go along with the advice of the surgeon you like and trust.

I had a non robotic laparoscopic right radical nephrectomy which apparently was a success. While in the recovery room my blood pressure dropped (to 40) and I required emergency surgery to find and fix a leaking artery.  That gave me a midline cut from my sternum to below the navel. I also got 12 units of blood.

So, I will make a couple of points.  The first is that my recovery has not been difficult. I was in hospital for 9 days instead of 2 or 3 but everything is healing well and my pain levels were minimal.

My second point is that 'surgeons like a challenge' sounds too much like 'surgeons will take risks'. I don't know why my artery leaked but I suspect it would have been less likely if the surgery was less challenging.

I'll make a third point. The next most important result after surviving the operation is that the surgery removes all of the cancer. I think he is saying that this is more likely with an open nephrectomy.

Steve.

icemantoo's picture
icemantoo
Posts: 3235
Joined: Jan 2010

Tesla,

 

Many of the older surgeons were not traiined in Laroscopic or robotic procedures and as such the choices they give you are limited, This does not mean he is not an excellent surgeon. If you have any doubs seek a second opinion. Mine was Laproscoppic before they had the robot almost 15 years ago.

 

Icemantoo

Jan4you's picture
Jan4you
Posts: 1322
Joined: Oct 2013

If this was me, I would get a 2nd opinion from a surgeon skilled in robatic/laproscopic surgeries. If they too recommend OPEN, then you'll know for sure. Sorry for what you are going through hon,

Warmly, Jan

lobbyist0724's picture
lobbyist0724
Posts: 392
Joined: Sep 2016

I recalled my doctor mentioned that one of the reasons he recommended open surgery for me is because it is cystic. (he is an expert in Laparosopic surgery).

Take care,

Carmen

foxhd's picture
foxhd
Posts: 3183
Joined: Oct 2011

I had an open. I healed perfectly. I don't know if your doctor is correct re: your surgery or not. But that isn't your real question. I wonder if you are more concerned with getting it removed in a way that least impacts your life style, vs having an incision where more can be thoroughly examined. Think carefully. Why would you bet your life on this? Besides a robotic isn't a walk in the park for everyone either.

APny's picture
APny
Posts: 1956
Joined: Mar 2014

I also had an open partial for a tumor a little smaller than yours. My surgeon at Sloan Kettering told me the same thing as yours did and then let me decide whether to stay with him or switch to his colleague for robotic. I'm glad I opted to stay with him. I know common wisdom here is that robotic/lap is easier recovery but I can't imagine a quicker and easier one than I had. Surgery monday morning, up walking Monday evening, home Wednesday afternoon and working at my computer Thursday morning. If robotic would have made it easier I guess I'd have been home Monday night, lol. I only have one single scar a bit under 5 inches and I'm glad I didn't have all those holes to contend with and worry about infections from so many openings. No it wasn't a walk in the park but then no surgery is, regardless of procedure. Best of luck to you!

Bay Area Guy's picture
Bay Area Guy
Posts: 386
Joined: Jun 2016

Hi Tesla.  I think if you trust the surgeon, you go with what he or she recommends.  I agree with a couple of my colleagues here who say that the most important issue is to get the entire thing out so you can recover and go on with your life.  I had a robotic assisted partial for my RCC.  But I've also had open surgery on my intestines a couple of times.  There's no doubt the recovery is rougher with the open, but if the surgeon is more comfortable that you'll have a better long term prognosis with an open, I'd go with an open.

Tesla1
Posts: 46
Joined: Mar 2017

I'm going to stick with my surgeon and go with the open procedure. Hoping I have APny's experience and not Steve's (no offense Steve)! Having said that it sounds like Steve still had a successful outcome. The tumor does have some cystic characteristics based on MRI images (based on my diagnosis as a MRI tech) but the Dr didn't say it was cystic based on the CT scan he saw. 

Thanks so much for your responses. 

By the way, how do I read yall's (yes I'm a Texan) previous posts? I don't see an option to do that when I open your profile.

 

Steve.Adam's picture
Steve.Adam
Posts: 460
Joined: Oct 2016

I don't think there is a way to view someone's posts. You can search for keywords in the body of posts but that only helps if people sign their messages. My only other suggestion is to browse backwards through the list of titles for potentially interesting subjects. You could probably read an entire month of messges in an hour or less if you skip those that are less interesting to you.

I feel very very lucky about my health generally and especially that this rcc was found and removed. I hope your experience is even better than mine.

Steve.

APny's picture
APny
Posts: 1956
Joined: Mar 2014

Tesla, if you put someone's user name into the search box (keyword is better than title but try both) you should get quite a few of their previous posts.

lobbyist0724's picture
lobbyist0724
Posts: 392
Joined: Sep 2016

The cystic component might be the reason then, since the doctor wants to avoid rupture of the tumor during the surgery. On the bright side, some research also shows that cystic tumor tend to have better prognosis ;)

So, the key is to stay healthy before the surgery since that will help you to recover faster and avoid unneccesary complications. Take care. Carmen

jason.2835
Posts: 337
Joined: Nov 2014

Tesla,

I've gone on record here as pushing the robot over open in the past because I've had both kinds for 2 different surgeries and I can attest that the recovery is VASTLY different for each surgery.  However, I have to agree with most of the sentiment on here.  Open procedure has good outcomes as well and if there's a chance that another surgeon could miss part of the tumor, go with the doctor that you're comfortable with.  Yes, a lot of the robotic surgeons are younger "hotshots" (I think mine would have fallen into the category lol) but thats not a reason to operate on someone, because they like the "challenge."  

- Jay

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