State's first single incision robotic kidney removal

“We made several improvements in the technique that could allow us to perform this type of procedure routinely,” says Craig Rogers, M.D., Henry Ford's director of robotic renal surgery. He performed the delicate operation last week using the da Vinci Surgical System, which has already been used in thousands of successful surgeries for complete and partial removal of diseased prostates.

The kidney, damaged by four tumors, was extracted through an incision of about three inches near the patient's navel of a 50-year-old patient during a complex minimally invasive robotic procedure that lasted approximately 2.5 hours.

The procedure takes its name in part from its minimally invasive approach: SIRS or Single Incision Robotic Surgery.

“We traditionally try to save the kidney for smaller tumors, performing a robotic partial nephrectomy”, says Dr. Rogers. “For larger tumors, however, patients would get a very large incision on their side. Now, we can remove kidneys with cancer through a single three- inch incision near the patient's belly button.”

The potential benefits to performing the SIRS nephrectomy are improved cosmetics, quicker recovery times, less scarring and blood loss.

Dr. Rogers and his colleagues have also pioneered robotic surgery for smaller kidney tumors, allowing them to perform a partial nephrectomy to remove tumors that might otherwise require total kidney removal or a large open incision. While these procedures are considered revolutionary because they preserve the healthy portion of the kidney and shorten recovery time, they are not practical for patients with large tumors.

“I think this is going to be a big advance for having to remove the entire kidney because of large kidney tumors. This could be a great improvement over traditional open and laparoscopic surgeries.” Henry Ford doctors have performed more than 130 robotic kidney surgeries using four or five incisions of less than one inch. When Henry Ford doctors perform robotic surgery with the da Vinci system, a camera and small robotic instruments are inserted through small incisions and controlled by the surgeon from a nearby console machine.

In the SIRS procedure, Dr. Rogers inserts the robotic arms through a single incision near the belly button, and sits at a nearby machine controlling the robot throughout the operation.

“I control every movement made by the robotic arms,” says Dr. Rogers. “The robotic instruments are like having my hands inside the body.”

Working through the single small incision, the robot-assisted surgeon inflates the abdomen; moves the large intestine aside to reach the kidney; clips or ties off the vein and artery that take blood to and from the kidney; detaches the rest of the kidney, and removes it.

Kidney cancer is diagnosed in approximately 55,000 people a year and the most common treatment option is an open surgery with a large incision about a foot long. Surgeons sometimes must remove a rib, and they must go through muscle to remove the kidney. Recovery can be up to two months with a weeklong hospital stay.

Besides cancer patients, candidates for SIRS nephrectomy include those with nonfunctioning kidneys due to blockage, stones, or congenital abnormalities.

This week's innovative and successful kidney procedure comes after Henry Ford has established itself as the leading facility worldwide for robot-assisted surgical treatment of prostate cancer. More than 4,000 such procedures have been performed by Henry Ford surgeons since 2001.

“We think we'll see the same advantages with robotic kidney surgery as we have with robotic prostatectomy,” says Dr. Rogers.