Focusing On Patients

Finding better ways to treat kidney cancer
(continued)

Conventional kidney cancer surgery requires a 10-to-12 inch incision that cuts from the belly button to the middle of the back. It slices through three muscle groups, nerves and sometimes requires removal of a rib. Most patients are in the hospital for eight days. Some have nerve damage indefinitely.

With laparoscopic nephrectomy, the surgeon makes four tiny incisions into the abdomen and inserts a viewing scope and a pencil-thin cutting tool. Carbon dioxide is pumped in through one of the incisions to puff it up for better access and give room for the organs to be moved around. Tubes are placed into three of the four incisions to act as channels for the camera and the instruments.

Das prefers to use his hand to remove the kidney, so the incision is as big as his glove size: two and half inches.

"I prefer to remove the kidney intact because I think you get better staging results that way," he says. "Other surgeons prefer to remove it in small pieces."

Laparoscopic cancer surgery is more complicated than surgery to remove a diseased organ because the surrounding fat and tissue must be removed for analysis by a pathologist.

Dr. Sakti Das, a professor of Urology at UC Davis, has taught seminars in laparoscopic technique throughout the world.