New technique for minimally invasive robotic kidney cancer surgery

Urologists at Henry Ford Hospital have developed a new technique that could make minimally invasive robotic partial nephrectomy procedures the norm, rather than the exception for kidney cancer patients. The technique spares the kidney, eliminates long hospital stays and provides better outcomes by giving the surgeon more time to perform the procedure.

Dubbed ICE for Intracorporeal Cooling and Extraction, the technique may allow more kidney cancer patients to avoid conventional open surgery – now used in the vast majority of cases – and its possible complications, including infection, blood loss, and extended hospital stays.

The Henry Ford study was published this week in European Urology, the official journal of the European Association of Urology.

"The study demonstrated that there's a two-pronged benefit," says Craig G. Rogers, M.D., director of Renal Surgery at Henry Ford Hospital's Vattikuti Urology Institute.

"Our goal was to protect the kidney from damage during a minimally invasive partial nephrectomy, and from a cancer standpoint, we have the added security that we've removed more of the tumor."

In the latest research, Henry Ford surgeons used robotic techniques to operate on seven kidney cancer patients between April and September 2012. In each case, they performed a partial nephrectomy, in which just the cancerous portion of the kidney is removed.

"What we've done is utilized a special type of device called a GelPoint trocar, that makes it easier to pass large things in and out of the abdomen through small incisions during minimally invasive surgery," says Dr. Rogers.

"Through the gel point, we take a syringe that's been modified so we can pack and deliver ice through the body to the kidney. So when we clamp the blood supply to the kidney, it's packed in ice just as it would be in an open surgery.

"Once the tumor is removed, instead of setting it aside in the body so you can sew up the kidney, we can remove the tumor as soon as it's excised through the gel point, look at it and decide if we're happy with what's been removed. If there's any doubt, I can go right back in and cut more out."

Dr. Rogers wrote in the study that others have tried various techniques to cool the kidney in minimally invasive surgery, but they "require specific equipment or expertise and are too complex or impractical for routine use."

"Unfortunately, the majority of people today diagnosed with kidney cancer get their entire kidney removed," Dr. Rogers says. "Not only that, they're getting it removed through an open approach, though a large incision that often requires removal a rib, when there are minimally invasive approaches, such as robotic surgery, available."

One of the reasons more patients aren't given the option of a partial nephrectomy is because for the surgeon, it's technically challenging to do and much more difficult to perform than taking the entire kidney out.