An article from the Fall 2012 issue of MyGeorgetownMD.
Gene Carter is comfortable with technology.
After all, the retired finance professor and corporate board member began programming computers in the 1960s when they were the size of a room.
So, when MedStar Georgetown University Hospital urologist Keith Kowalczyk, MD, told Gene that he planned to remove his kidney tumor using a robot and dye that would light up his kidney, arteries and veins like a green glow stick, he was game. “I appreciate what technology can do,” says Gene. “The approach Dr. Kowalczyk described seemed prudent. It didn’t bother me at all.”
Gene learned that he had kidney cancer during a magnetic resonance imaging (MRI) study for an unrelated problem. The incidental discovery of kidney tumors is common. “Although sometimes there is pain or blood in the urine, kidney cancer does not usually present symptoms, and is typically discovered during unrelated diagnostic procedures,” says Dr. Kowalczyk.
Dr. Kowalczyk uses a state-of-the-art procedure called robot-assisted partial nephrectomy with Firefly™ fluorescent imaging. He performs this procedure using the daVinci® Si™ robotic surgical system.
Partial nephrectomy is a surgery that addresses cancerous and noncancerous tumors. With this procedure, the surgeon removes the kidney tumor and a small portion of surrounding tissue, but leaves the rest of the kidney in place. The American Urological Association 2009 clinical guidelines recommend partial nephrectomy as a standard treatment, when technically possible, in patients with small kidney tumors that have not spread. The addition of Firefly has made partial nephrectomy a possibility for patients who previously would have required total kidney removal.
However, the predominant treatment for kidney tumors is still to remove the entire affected kidney. A popular way of performing this procedure is with laparoscopic or minimally invasive surgery. Laparoscopic surgery means the patient has a few tiny incisions, experiences less pain and bleeding and is usually in the hospital for just one night.
Despite laparoscopic kidney removal’s relative ease on the patient, “research shows that partial nephrectomy for the treatment of small renal tumors is associated with better outcomes, including cancer survival, over other treatments, even if it can’t be done laparoscopically,” Dr. Kowalczyk says.
“We know that you can live with only one kidney,” says Dr. Kowalczyk. “This knowledge has led to living kidney donation and has benefitted countless people on the national organ donor list. But patients with kidney cancer are different than kidney donors. They will do better and be healthier in the future if we can save as much of the kidney as possible.”
The urology team at MedStar Georgetown uses the kidney-sparing surgery whenever possible. “Robotic surgery offers a clear-advantage in kidney surgery,” says Dr. Kowalczyk. “Surgeons can see their work in 3D, and the tiny robotic arms offer more dexterity and precision in reaching difficult areas. This results in a faster surgery, smaller incisions, less blood loss, and less pain. The patient can usually go home in one day, and it requires much less pain medication.
“With Firefly, I will attempt a partial nephrectomy for much larger tumors that would not be prudent using other approaches,” says Dr. Kowalczyk.
The use of Firefly imaging during a robot-assisted procedure improves the safety and results of the procedure even more. Because surgeons can see everything more clearly, this technique increases the surgeons’ chances of removing only the tumor in cases that might result in loss of the entire kidney using alternative methods.
With Firefly, a dye called indocyanine green (ICG) is injected into the blood. The dye lights up “firefly green” through a specialized camera. “With this technology, we can see the exact blood supply for both the kidney and the tumor, and distinguish between the cancerous and healthy tissue,” says Dr. Kowalczyk. “It shows us where we should — and shouldn’t — cut. The process allows us to avoid additional renal arteries during the procedure, remove the entire tumor and its edges and ensure that the kidney’s blood supply has been thoroughly restored when we are finished.”
Gene, a husband, father and avid traveler who has no interest in slowing down, feels that he got the best treatment combination. “Although I am still recovering from the surgery, if I had a more invasive procedure, it would have been much more difficult,” he says. “I got to keep my kidney and avoid the pain of a big operation.”
Risk Factors for Kidney Cancer
- Cigarette smoking
- High blood pressure
- Family history of kidney cancers
Source: National Cancer Institute, http://www.cancer.gov/cancertopics/wyntk/kidney/page4