Kidney Surgery From Two Directions: Russian Urologists Identify a Better Approach to Tumor Removal
Russian surgeons have compared two surgical approaches for removing kidney tumors and found that one offers clear clinical advantages. The findings could improve surgical safety and support broader adoption of robotic surgery in Russian urologic oncology.
Clinicians at Sechenov University compared two approaches to robot-assisted partial nephrectomy for removing kidney tumors. One accesses the kidney through the abdominal cavity, while the other reaches it through the lower back using a retroperitoneal approach. The study found clear advantages for the latter: reduced blood loss, faster patient recovery and a higher safety profile.
Faster and More Effective
The study was conducted at the Institute of Urology and Human Reproductive Health at Sechenov University. Researchers analyzed data from 285 patients with T1a and T2a kidney tumors. They divided them into two groups: 21 patients underwent surgery using a retroperitoneoscopic approach through the lower back, while 36 patients received the conventional transabdominal procedure through the abdominal cavity.
The surgeons found that the retroperitoneoscopic approach offers several advantages. The first is reduced blood loss. According to the institute, average blood loss was 84 milliliters per patient, compared with 103 milliliters for the transabdominal procedure. Recovery of bowel function and other organs was also faster after surgery through the lower back. Postoperative pain was likewise less pronounced.
But the most important advantage of robot-assisted partial nephrectomy emerged during one of the procedure's most demanding stages – closing the surgical wound after the tumor had been removed. Unlike laparoscopy, where the needle and suture material must be manipulated manually, the robotic system allowed surgeons to perform the closure with exceptional precision and without unnecessary punctures. As a result, blood loss declined and warm ischemia time – the period during which blood flow to the kidney is temporarily interrupted – was also reduced. That directly affects organ preservation: the shorter the ischemic interval, the more quickly the kidney can recover.
Preserving the Kidney
Kidney cancer is one of the most common malignancies in urologic oncology. At the same time, the kidneys perform essential functions, including filtering toxins from the blood, maintaining fluid balance and regulating blood pressure. Organ-preserving procedures, in which only the tumor is removed rather than the entire kidney, are becoming increasingly common. The more precise and safer the surgical approach, the greater the likelihood of preserving kidney function while reducing the risk of complications.
In practice, for patients, a robotic procedure performed through the lower back instead of the abdominal cavity offers a higher level of safety, fewer complications, faster rehabilitation and a quicker return to normal life.
The Final Decision Belongs to the Surgeon
For more complex cases, the clinic also uses three-dimensional computer modeling. Before surgery, clinicians create a virtual model of the patient's kidney, including the tumor, blood vessels and urinary tract, allowing every stage of the procedure to be planned in detail. During surgery, ultrasound navigation is used to identify the tumor's boundaries in real time.
The surgeons believe the retroperitoneoscopic approach is considerably more convenient, particularly for tumors located on the posterior surface of the kidney. Even so, the choice of surgical approach should always be individualized. Surgeons must take into account the tumor's location, size and anatomical characteristics.
The Next Step: Sharing Experience
Sechenov University is one of Russia's leading medical centers. When studies like this are published, they often become reference points for other clinics. The experience of Sechenov's urologists can be adopted by regional oncology centers as they introduce robotic surgery.
The study's findings may also prove valuable beyond Russia. Choosing the optimal approach for robot-assisted partial nephrectomy remains an important question for surgeons worldwide. The next step, therefore, is to accumulate additional clinical evidence, incorporate the results into clinical practice guidelines and train surgeons using robotic simulators.
