Mediclinic City Hospital in Dubai recently undertook two intricate and challenging cases utilising the Da Vinci robot for the removal of kidney cancer from two patients with a solitary kidney.
Successfully performing such demanding robotic surgical procedures is a rarity, with only a few centres equipped for such complexities.
Robotic surgical excision stands out as the optimal approach for achieving effective cancer control in cases of kidney cancers. This involves either total removal, known as radical nephrectomy, or selectively removing the renal tumour while preserving the normally functioning kidney tissue, referred to as nephron-sparing surgery or partial nephrectomy. When managing renal cancer in individuals with a single kidney, the task becomes uniquely challenging, as the preservation of the normally functioning kidney is equally crucial to achieving a complete cancer cure. In such cases, nephron-sparing surgery becomes the sole modality.
Approximately 1-2 per cent of the population possesses only one kidney, either from birth or due to later loss caused by factors such as cancer, trauma, kidney stones, or other reasons. Tackling a tumour in a solitary kidney poses a formidable challenge, as the objective is not only to eradicate cancer but also to safeguard enough kidney function to prevent the necessity for dialysis. Dr Mudhar Hasan, consultant robotic urologist and head of the urology department at Mediclinic City Hospital, who led and performed these surgeries, emphasised the difficulty, stating, “Tumour in a solitary kidney is one of our biggest challenges as we have to remove cancer but also aim to save enough kidney to allow patients to stay off dialysis.”
During the surgeries, the usual practice involves temporarily closing the blood supply of the kidney by clamping the blood vessels. However, in an effort to preserve maximum kidney tissue, the surgical team operated swiftly without clamping the vessels, minimising damage caused by the temporary interruption of the blood supply.
Post-surgery, the patients exhibited remarkable and smooth recovery. Adequate urine output without the need for dialysis indicated a well-functioning kidney. Although the patients’ creatinine levels (a marker of kidney function) initially rose after surgery, they rapidly normalised within a few days, returning to pre-surgery levels.
Mediclinic City Hospital is dedicated to delivering a high level of surgical expertise and utilising the latest technology to serve our patients.