While the origins of laparoscopic urologic surgery date back to the late 1980s, the use of robotic partial nephrectomy (RPN) was initially reported in 2004. With the evolution of medicine and technology, robotic partial nephrectomy has gained immense popularity in the treatment of many urological conditions, including kidney cancer in Singapore, as well as around the globe. But what exactly is RPN, how does it work, and what benefits are associated with this procedure? This article will guide you through all these questions and more!

Robotic Partial Nephrectomy 

Before delving into robotic partial nephrectomy, let’s walk through nephrectomy and what it entails. It involves surgically removing the kidney in order to treat a number of kidney diseases and injuries, as well as for the purpose of kidney transplantation. This procedure can be classified into radical, simple, and partial nephrectomy. A radical nephrectomy is a common inpatient surgery that involves the removal of the entire kidney and some surrounding tissues that is typically carried out for cancers, whereas a simple nephrectomy involves the removal of the kidney, which is usually done for non-cancerous indications like infection. A partial nephrectomy is essentially a kidney-sparing surgery in which only a part of the kidney with the tumour is removed.

While both radical and partial nephrectomy can be carried out as open surgeries, these procedures can also be performed either laparoscopically or through a robot-assisted technique – Robotic radical nephrectomy and robotic partial nephrectomy. However, the suitability of each procedure will be determined by the urologist based on the patient’s condition, along with certain other criteria that must be met.

Robotic partial nephrectomy works with the help of high-definition 3D magnification, robotic technology, and specialised miniature instruments. It is performed by making a few small keyhole-sized incisions, through which tiny robotic instruments and slender ‘robotic arms’ will be inserted into the body. Following this, the surgeon will manoeuvre these instruments using the arms through a robotic console situated just a few feet away from the patient.

Benefits of Robotic Partial Nephrectomy

Robotic partial nephrectomy comes with several benefits, including an increased range of motion and flexibility, along with enhanced visualisation and precision, allowing the doctor to make meticulous suturing and dissections. However, many more advantages come with undergoing a robotic partial nephrectomy; let’s walk through a few of them:

• Minimally invasive: In contrast to conventional open surgeries for kidney disease or kidney cancer in Singapore, the involvement of keyhole-sized incisions helps reduce major scarring, significant tissue trauma, and heavy blood loss.
• Reduced pain and complications: Due to their minimally invasive nature, they are also associated with reduced pain and discomfort. Therefore, in comparison to open surgeries, patients don’t usually need a lot of post-operative pain medication. In addition, they are also associated with fewer risks or complications, such as infection and blood loss, making the procedure suitable for kidney cancer management.
• Shorter hospital stay: Patients who undergo robotic partial nephrectomy tend to experience quicker recoveries along with shorter hospital stays, allowing them to resume their normal activities sooner. 
• Renal function preservation: Partial nephrectomy is usually carried out to make sure that healthy kidney tissue is spared as much as possible so that the kidney function is minimally/not affected. This is particularly important in patients who only have one properly functioning kidney.
• Well-suited for complex kidney treatments: The benefits of enhanced precision, panoramic viewing with enhanced dexterity and freedom of movement make robotic partial nephrectomy the ideal procedure for complex procedures like kidney cancer removal and kidney reconstruction.

Conditions that can be managed by Robotic Partial Nephrectomy

Robotic partial nephrectomy is primarily used for the treatment of kidney cancer in Singapore. But there are a number of other conditions that can be managed by this procedure. They are as follows:

• Benign kidney tumours: Certain non-cancerous kidney tumours like large angiomyolipomas that have a high risk of bleeding or a possibility of turning cancerous can also be removed with the help of this procedure.
• Kidney cancer recurrence: Patients who experience a localised kidney cancer recurrence even after kidney cancer treatment may require robotic partial nephrectomy for management.

Who is eligible to undergo this procedure in the treatment of kidney cancer in Singapore? 

While most patients can undergo robotic partial nephrectomy, the suitability can only be determined by an experienced and qualified urology specialist like Dr Terence Lim. Here are some factors that may play an important role in this decision-making:

• Patient profile: The patient’s age, body mass index (BMI) and overall health.The site, size and stage of kidney cancer: RPN is typically performed for smaller, early-stage cancers.
• Unfavourable conditions: This procedure is not feasible if  the tumour is too large or involving too much of the kidney or its surrounding tissue.

What is the importance of having an experienced surgeon to perform this procedure? 

Although this procedure is carried out with the help of robot-assisted technology, it can only be performed by a doctor like Dr Lim, who has undergone extensive specialised training and possesses the required skills in carrying out robotic urologic surgeries like robotic partial nephrectomy. With years of experience handling numerous patients and being involved in over 700 robotic urologic surgeries, he is well-equipped to handle even the most complex cases.

While this procedure is generally considered to be safe and effective, the development of certain complications is possible. This is where his qualifications and experience will come in handy when making critical decisions to ensure optimal outcomes. As a Senior Urology Consultant, Dr Lim is also frequently asked to mentor his colleagues and subordinates for a number of robot-assisted procedures and is often called upon to perform multi-disciplinary robotic surgeries. 

Dr Lim is also a strong advocate of improving patients’ clinical outcomes with safe technologies and clinical initiatives, and his tireless efforts have not gone unrecognised. Under his leadership, the Department of Urology in Singapore won the Department Quality Award throughout his tenure as Head of Department. Moreover, his subspecialty lies in Uro-Oncology, and he has a keen interest in minimally invasive surgeries like robotic partial nephrectomy that enable a good outcome in most cases.

Want to explore more about robotic-assisted surgeries and how they can help with treating urological cancers like prostate and kidney cancers in Singapore? Feel free to browse our article on robotic surgery or reach out to our friendly team at Assure Urology & Robotic Centre, who will help you with any questions or concerns that you may have.

Frequently Asked Questions

What pre-operative preparations are essential for Robotic Partial Nephrectomy?

Your doctor will provide you with a list of instructions to follow before the procedure, including advice such as refraining from taking blood thinners, avoiding alcohol consumption (48 hours before the surgery) and fasting before the procedure (after midnight on the day before the surgery).

What can I expect after a Robotic Partial Nephrectomy?

While most patients are discharged within two to three days following the procedure, they can resume their normal activities between two to four weeks after the surgery. But one must be careful to avoid carrying out any strenuous exercises or activities like weight-lifting or swimming.

Can a urologist perform my Robotic Partial Nephrectomy?

Yes! In fact, as discussed earlier, only a urologist who is trained and experienced in robotic surgery can perform this procedure.

Is Robotic Partial Nephrectomy Safe?

Yes. It is safe and effective, especially when it is carried out by an experienced medical professional. However, some potential side effects, such as abdominal bloating and infection, may develop following the procedure in some patients with kidney cancer in Singapore.

Who should not undergo a Robotic Partial Nephrectomy?

If a patient is critically ill and has several medical conditions and comorbidities, they might be advised to refrain from undergoing this procedure until their condition improves.