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Robotic surgery and the battle against kidney cancer

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da Vinci Surgical System

Chris Anderson and the da Vinci Surgical System

In 2013, a new surgical procedure was used for first time in the UK at St George's Hospital, London to remove of a cancerous kidney tumour.

The procedure combines the da Vinci surgical system with an injection of a dye into the patient's kidney. The dye illuminates healthy tissue and shows up under the da Vinci's camera as a bright green light and as a consequence the procedure is called Firefly.

Chris Anderson, a consultant urologist at St George's is one of the early adopters of robotic surgical techniques after receiving specialist training in 2005 at the world renowned Henry Ford Robotic Center in Detroit. Anderson has built-up a leading renal cancer unit at St George's and introduced the Firefly technology into the UK. He says, "Partial kidney removal is a complex operation that requires complete removal of the tumour and reconstruction of the remaining healthy kidney. By combining the da Vinci system with Firefly we are able to achieve our goal better than in the past".

Robotic surgery
Kidney surgery is enhanced by robotics. In recognition of the increasing importance of high tech surgical therapies, the N Sethia Foundation funded the UK's first robotic surgery training centre at University College Hospital, London. In pride of place in the new Chitra Sethia Centre for Robotics and Minimal Access Surgery is the latest da Vinci surgical system.

Professor John Kelly, the Centre's director, said, "The system provides the surgeon with a much greater movement than the human wrist is capable of. As a surgeon, you can see the instruments and tissue in 3D and highly magnified. The movements are very controlled and precise and of course we want to see this translate as improved outcomes for our patients".

The da Vinci surgical system
The da Vinci surgical system is a sophisticated robotic platform designed to expand the surgeon's capabilities and offers state-of-the-art minimally invasive options for kidney and other major surgeries.

The surgeon sits at a control console, which senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate tiny instruments and a high resolution 3D camera at the surgical site inside the body. The system also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically.

Approved by the FDA in 2000, by 2013 over 2,000 da Vinci systems had been sold and an estimated 200,000 annual surgeries are currently conducted using the system. More commonly it's used for prostatectomies, but increasingly for cardiac valve repair, gynaecologic and kidney surgical procedures.

The kidneys and cancer
Kidney cancer kills, it's difficult to diagnose and it's on the increase.

The kidneys are two vital bean-shaped organs located on either side of the body just underneath the ribcage. Their function is to filter blood and remove waste products, which they convert into urine.
The kidneys also help to control the balance of fluid, salt and minerals in the body and to maintain blood pressure.

Over the past decade kidney cancer diagnosis has increased by 33% in England, while in the US there has been an increase of 50% in the past 30 years. Risk factors include excessive alcohol consumption and obesity.

Kidney cancer is the eighth most common cancer in the UK and in 2010 some 9,600 people were diagnosed with the disease. In Europe an estimated 73,000 people were diagnosed with kidney cancer and worldwide more than 273,000. The disease kills and the death toll is increasing. In 2010 in the UK 4,100 people died of kidney cancer, 31,300 in Europe and more than 116,000 worldwide.

The majority of deaths from the disease could be avoided by early diagnosis: hence the importance of reporting "blood in your pee". Other symptoms include needing to urinate often or suddenly, pain while urinating, pain below the ribs that doesn't go away and a lump in your stomach.

A nephretomy
An established surgical therapy for kidney cancer is a nephretomy: the complete removal of the kidney. Usually, this involves making an incision between the lower ribs on the side of the tumour, removing the diseased organ, some surrounding tissue and often the lymph nodes close to the kidney to check if they contain any cancer cells.

Although a major surgery, it is preferred by some surgeons who believe that it reduces the chances of the recurrence of the disease. A person can live a completely normal life with just one kidney.

Takeaway
Given the growing incidence of late stage kidney cancer, the battle against the disease increasingly includes high-tech surgical therapies such as the da Vinci surgical system.

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Robotic surgery and the battle against kidney cancer

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