Laparoscopic Partial Nephrectomy: In laparoscopic partial nephrectomy, there is not an efficient method to cool the kidney as in open surgery. As a result, tumor resection and kidney reconstruction is limited to 30 minutes from the moment the kidney vessel is clamped lest the kidney suffer irreparable damage. Angle of approach to the tumor matters. It's important, therefore, for the operating surgeon to be facile with both transperitoneal and retroperitoneoscopic approaches to video telescopic surgery. (In transperitoneal laparoscopy, the kidney tumor is accessed through the abdominal cavity from front to back. In retroperitoneoscopic surgery, the kidney tumor is accessed directly in the flank, which gives better access to the backside of the kidney). Dr. Kaynan is one of only few in the New York Metro Area with this skill set.
daVinci Partial Nephrectomy: Robotics adds an additional layer of finesse to the reconstructive aspects which potentially improve accuracy and precious time. Further, it broadens the range of patients who are candidates for a laparoscopic partial nephrectomy. This is now the preferred method for most small kidney tumors being removed transperitoneally.
As in total nephrectomy, the virtues of laparoscopy (and robotics) as it applies to partial nephrectomy compared with open surgery include:
Note that for the larger, deeper, or central tumors subjected to laparoscopic / robotic partial nephrectomy, there is a higher chance of significant bleeding, urinary leak, re-operation, and loss of kidney. Therefore, this approach to kidney tumor resection must be weighed carefully against the other options. The operating surgeon must be facile with all methods of kidney tumor removal, as is Dr. Kaynan, in order to handle this type of surgery.