Robotic Surgery in Kidney Tumor Treatment
The gold standard in the treatment of localized kidney tumors is surgical resection.
In recent years, there has been a trend towards partial nephrectomy in cases. The reason for this trend is the fact that chronic renal failure is more common in patients who underwent radical nephrectomy, even if other renal functions are normal pre-operatively, and therefore, the desire and aim of preserving renal functions as much as possible.
The use of the da Vinci system (Intuitive Surgical Corporation, Sunnyvale, California, USA) is increasing, especially in radical prostatectomy. Possible advantages of robot-assisted laparoscopic surgery over laparoscopy; Robot-assisted laparoscopic radical and partial nephrectomy is laparoscopic and open nephrectomy.
Technique: Robot-assisted laparoscopic nephrectomy is performed under general anesthesia. The anesthesia team should be alert for the effects of CO2 insufflation and pneumopertonium, such as oliguria and hypercarbia. The basics of surgical dissection in robot-assisted laparoscopic nephrectomy are similar to the laparoscopic method. In the transperitoneal method, the patient is placed in the lateral position (45 -60°), and the pneumoperitoneum is created by entering with a Veress needle as in the laparoscopic method. Then, the robot-assisted laparoscopic arms and the necessary ports for the assistant are placed and the surgery is started.(17)
(Robot Assisted Minimally Invasive Surgery):
The operation is performed over the robotic arms sent to the target anatomy through incisions made on the patient’s abdominal wall. One of the incisions is used for the camera that sends a 3D HD, real, simultaneous view of the operating field to the surgeon’s console. The surgeon manages the robotic instruments using his console. In this way, it reaches very narrow areas and has the chance to perform maneuvers that cannot be done by human hands. In addition, it eliminates the hand tremor problem experienced in laparoscopic surgery and can perform rotation maneuvers that laparoscopic instruments cannot. The 3D HD image quality provided to the surgeon is one of the features that distinguishes robotic surgery from laparoscopic surgery. In robotic radical nephrectomy surgery, it feeds the kidney and carries the dirty blood in the kidney.
After the vessels are identified and closed, the connection of the kidney with these vessels and the ureter is cut. The kidney, which is separated from the surrounding tissues, is removed from the body and the operation is terminated. In robotic partial nephrectomy surgery, after the tumor area is determined and marked with an instant ultrasound image during the operation, thanks to a feature offered by the da Vinci Robotic Surgery System, the vessels that feed the kidney and carry the dirty blood from the kidney are closed for a short time. After the tumor is separated from the kidney and the removed area is closed, the blood inlet and outlet in the veins are opened. The operation is terminated by removing the tumor from the body. The very small incisions made in robotic surgery allow the patient to return to his daily life faster after the surgery.
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