New Hand-assisted Laparoscopic Technique for Kidney Cancer Surgery

Medical College of Wisconsin urologists at Froedtert Hospital and the VA Medical Center Milwaukee are the first in Southeastern Wisconsin to use a new technique for kidney removal in cancer patients with small primary kidney tumors.

The new technique, hand-assisted laparoscopic nephrectomy, offers the advantages of two surgical techniques: the smaller incisions and shorter recovery times of laparoscopic surgery, and the option of removing a completely intact kidney afforded by conventional surgery, according to Frank P. Begun, MD, Associate Professor of Surgery in the Division of Urology at the Medical College.

"It is also an ideal approach for elderly patients, who may be too frail for conventional surgery, which could be very debilitating," he said.

In September, Dr. Begun performed the first of three successful procedures to date. The first were to remove non-functioning kidneys, and the most recent was removal of a kidney with a small, primary kidney cancer tumor in an elderly patient.

The technique involves a two-to-three inch incision above the belly button to permit the surgeon to insert his hand into the video-viewed operating field. Like other laparoscopic procedures, the field is also accessed via three tiny abdominal punctures to admit thin tubes: one for the lighted, fiber-optic camera, the others for introduction of tiny remotely operated instruments.

Its advantages are several, according to Dr. Begun, who says that the traditional surgery requires a 10- to 12-inch incision wrapped under the ribs, and sometimes involving removal of the lowest rib. "Recovery time for the new technique is two to three weeks, as opposed to four to six weeks for traditional surgery," he says. "The hospital stay is also shorter, an average of three days, versus four to five days."

Dr. Begun notes that intact kidney removal is very important in treatment of kidney cancer. "An organ must be crushed to be removed laporascopically," he says. "That destroys the integrity and architecture of any specimen, leaving no precise information about the margins or microscopic extent of a tumor."

Another advantage is use of the surgeon's hand, according to Dr. Begun. "The hand, with its acute tactile sensitivity and instant functional adaptation, is a marvelous surgical instrument," he says. "It can not only feel exactly where blood vessels are during surgery, but can also convert instantly into a hemostat, clamping them off in the event of bleeding."

Intact kidney removal is also vital to preserve organs from living donors for transplantation. Since March, Medical College transplant surgeons Christopher Johnson, MD, and Allan Roza, MD, Professors of Surgery, have successfully used the new technique to harvest kidneys from 15 living donors. None have experienced complications and all are doing well since their surgery.

The new technique is not appropriate for those with extensive surgical scarring or large kidney tumors. For more information on hand-assisted Laparoscopic nephrectomy, call the Medical College of Wisconsin Division of Urology at (414) 456-6950.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.