A growing number of urologists are using robots for partial nephrectomy. But not every surgeon who moves to robotic partial nephrectomy has the skills needed to perform the procedure well.
“Robotic partial nephrectomy is slightly higher on the value chart than many robotic procedures,” said Mihir Desai, MD, professor of Clinical Urology and Director of the Center for Advanced Robotics at the Keck School of Medicine at the University of Southern California. “As more urologists have more advanced robotic skills and access to a robot and want to do this operation, there are common complications that can be avoided or dealt with promptly if you have the training. Not everyone does.”
During Friday’s Prime Time plenary session, Dr. Desai will moderate a 30-minute panel discussion on Surgical Techniques: Tips & Tricks: Robotic Partial Nephrectomy, which begins at 10 am in the Esplanade Ballroom at Moscone South. The first part of the session will focus on essential steps to take during setup to minimize complications. A second session will focus on recognizing complications early and dealing with them expeditiously.
“Complications happen, but there are several critical technical steps that help minimize the complications in partials,” Dr. Desai said. “There are equally critical steps you take to recognize complications and deal with them early, before they can become serious.”
Patient selection is a key element in preventing complications. Every surgeon has a learning curve with robotic partials and must recognize their place on that curve. Surgeons with a fair amount of experience may be able to tackle more complex cases. Surgeons with less advanced skills should select less complex cases. Surgeons must recognize their own capabilities and limitations.
It’s just as important to set up the surgery appropriately. Setup is not just the robot and associated instrumentation, Dr. Desai noted.
Setup includes the entire surgical team — the assistant, the anesthesiologist, the nurses — and making sure everyone is on the same page and communicating freely. Good surgical planning, good execution and good communication can prevent complications and help the team recognize any complications early and intervene promptly.
There are also new techniques and technologies in instruments and imaging which can be used in specific scenarios to help identify problems before they occur.
“As a robotic surgeon, you never stop training because robotic practice is not static,” Dr. Desai said. “There are always new developments that can make your surgeries safer and more successful, but only if you keep up with the latest developments.”
The goal of partial nephrectomy is to remove as little tissue as possible while completely eliminating the tumor.
“If you try to get close to the tumor, you may get into it and, therefore, leave cancer behind,” Dr. Desai said. “And if you go wide to minimize residual tumor, you end up taking too much of the kidney. Achieving both objectives is a fine balance and the source of many complications.”
Bleeding is another significant source of complications. The kidney is a highly vascularized organ with perhaps the greatest blood flow per gram of tissue of any organ in the body. Recognizing the likelihood of bleeding, and acting proactively to minimize bleeding, can significantly reduce the risk of complications.
“Preventing and dealing with surgical complications is not something you can read about in a textbook or journal,” Dr. Desai said. “You have to see the prevention and management of complications in action to get the tips and techniques. We have an outstanding faculty with a very high level of experience and clear video showing just what can go wrong and how to deal with it. And we absolutely encourage attendees to ask questions.”