The term minimally invasive surgery is commonly used but, in my opinion, poorly understood. Wikipedia describes a laparoscopic- or robotic-assisted surgery as “minimally invasive,” but as someone who has spent over a decade performing these procedures, I can tell you they are NOT minimally invasive. They are better described as “moderately invasive,” especially when one sees just how minimally invasive an ablation can be.
The least invasive treatment option is active surveillance, which refers to monitoring the growth of a tumor using imaging studies. Thus, this option is actually not invasive at all. Most small tumors are very slow growing and can be safely observed in this manner. This treatment strategy involves no pain and no recovery time; however, it is limited to patients who have short life expectancies for other various reasons. Our team at the University of California Irvine recently published the largest series in the world about active surveillance. We studied over 200 patients with three years of follow up and found that a majority did well, with little growth of their tumors. Only one of the two hundred patients died of kidney cancer.
The second least invasive approach – and in my opinion the only truly minimally invasive one – is percutaneous ablation. This technique destroys cancer using ablation probes, as described above. The probes can be inserted with the guidance of a CT scanner under just mild sedation (relaxing medicine) and with local anesthesia. Patients who undergo this procedure can often go home the same or next day, requiring just a few days for a full recovery. One concern with percutaneous ablation is the radiation from the CT scanner. There are just a few centers in the world that can use MRI scanners, which do not use radiation, to perform kidney tumor ablations. The University of California Irvine is one of them. To see a percutaneous kidney cancer cryoablation procedure please visithttp://www.kidneycancerinstitute.com/percutaneous-video.html
Laparoscopic surgeries are, as mentioned above, “moderately invasive.” In these procedures surgical tools are inserted through small incisions in the skin, and either the entire kidney is removed (radical nephrectomy) or just part of the kidney (partial nephrectomy). For the past decade, urologists have been using the daVinci robotic system to facilitate laparoscopic procedures. With this system, the surgeon gets a three-dimensional view of the tumor and can make very precise movements using the robotic instruments. Both laparoscopic and robotic surgeries cause less pain and result in much shorter recovery times than open surgeries. They are, however, more technically challenging, so the urologist’s experience is a critical factor.
Open surgery is the most invasive treatment option, but it remains the gold standard by which the effectiveness of all other procedures is judged. Despite our extensive experience with the most advanced technologies, we use open surgery to treat about 15% of kidney tumors, typically the ones that are very large or complex.