Laparoscopic Surgery for Treating Kidney Cancer

What is Laparoscopic Surgery for Kidney Cancer?

Laparoscopic nephrectomy is a minimally invasive procedure designed to treat kidney tumors.

As a minimally invasive surgery, laparoscopic surgery offers a faster recovery, less pain, shorter hospital stay, significantly reduced blood loss, and a quicker return to normal life compared to traditional surgeries.

Like all laparoscopic surgeries, small incisions (between 5 and 10mm) are made in the patient's abdomen, through which surgical instruments are inserted. One of these instruments is a laparoscope, which has a video camera capturing images inside the patient's abdominal cavity, allowing the surgeon to operate while viewing the abdominal interior on a television monitor.

The procedure can be performed differently, depending on whether it's possible to remove only the tumor (partial nephrectomy) or if it's necessary to remove the entire kidney (radical nephrectomy). To decide on the best technique to use, it's important to consider both patient factors and tumor factors. Regarding patient factors, it's relevant to consider not only the patient's overall health and function but also any concurrent illnesses, regular medications (such as antiplatelet or anticoagulant drugs), and prior surgeries. As for tumor factors, it's essential to perform an examination such as contrast-enhanced computed tomography or nuclear magnetic resonance.

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What is the Procedure?

Laparoscopic surgery for kidney tumours, like all keyhole surgery, involves making small millimetre-sized incisions in the patient’s abdomen to insert the surgical instruments.

One of these instruments is a laparoscope with a video camera which films the patient’s inner abdominal cavity. This allows the surgeon to operate via a TV screen.

The kidney is fully removed (or partly in the case of partial nephrectomy) via an incision which is widened so the organ (or part of it) can be extracted.

This type of surgery may not be feasible for removal of very big tumours that invade the tissue around the kidney or the venous structures, like the inferior vena cava.

It is now possible to perform this type of surgical procedure with a robotic aid, providing more precise operation of the instruments. However, in radical nephrectomy, robotic aids do not make a significant contribution. In partial nephrectomy, they can make surgery simpler, but they are not essential, unlike other situations.

Laparoscopic Radical Nephrectomy

Laparoscopic radical nephrectomy is considered the gold standard for the treatment of large-sized renal lesions and in cases where performing a partial nephrectomy is not feasible. It involves the removal of the entire kidney, the perirenal fat, Gerota's fascia, and the lymph nodes adjacent to the renal vessels. In selected cases, the removal of the adrenal gland and lymph nodes adjacent to the abdominal aorta and inferior vena cava can also be performed simultaneously.

It may also be indicated in cases of more advanced kidney tumors, in combination with immunotherapy or for symptom control.

Laparoscopic Partial Nephrectomy

Currently, laparoscopic partial nephrectomy is considered the gold standard for the treatment of small renal lesions, as it allows for both oncological effectiveness and the preservation of renal function, along with a faster recovery.

Due to the extensive vascularization of the kidney, when this procedure is performed, it is often necessary to temporarily clamp the vessels that supply blood to it in order to minimize blood loss.

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What is the Post-Treatment?

Patients who undergo laparoscopic surgical treatment (both radical nephrectomy and partial nephrectomy) receive regular medical follow-up.

The main goals of post-treatment monitoring are the detection of potential disease recurrence (whether local, in the contralateral kidney, in retroperitoneal lymph nodes, or in other organs) and the surveillance of renal function.

The specific plan to be implemented primarily depends on the type of kidney tumor, which is categorized based on the pathological analysis of the surgical specimen and the prior staging. The type of treatment performed also affects the frequency of follow-up.

Typically, follow-up appointments are more frequent in the initial phase and may become less frequent over time. Usually, an evaluation is conducted through laboratory tests and imaging exams such as renal ultrasound, computed tomography, or nuclear magnetic resonance.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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