Robotic Kidney Surgery

Shelby Roth Kidney Surgery patientWhen Shelby Roth, 49, went for a routine physical, she never imagined it would lead to kidney surgery for a potentially cancerous mass. On March 21, Shelby underwent a partial nephrectomy—a partial removal of the kidney—at Milford Regional. Matthew Ingham, MD, performed the procedure using the latest in robotic-assisted surgery, the da Vinci Xi®. This advanced technology allows for more complex surgeries with fewer and smaller incisions.

“I think the robot has been one of the keys to a successful recovery,” notes Shelby, a financial analyst and certified health coach in Franklin. “Even a week later, I felt incredibly great. It’s not ideal that I had to have this done, but in all honesty, I couldn’t have had a better experience.”

Shelby had the surgery for a two and a half centimeter mass on her left kidney that had a high likelihood of being cancerous. If Shelby hadn’t gone for a physical, she would have never known about the mass. After her liver enzymes came back elevated slightly, her primary care doctor attributed it to a fatty liver and advised that she lose weight.

Despite shedding 20 pounds, when Shelby was retested, the levels were still elevated. Her doctor sent her for an abdominal ultrasound which revealed the mass. She went for a CT scan and was then referred to Dr. Matthew Ingham, of Urology Associates of Milford, to discuss surgery.

“We didn’t know how long the tumor had been there or how fast it was growing,” Shelby recalls. “I felt fine, so it was hard to consider kidney surgery, but I knew the importance of early diagnosis.”

She and her husband Bob met with Dr. Ingham who gave them the news that there was an 85 percent chance the mass was cancerous. However, Shelby left the office confident that surgery was the right decision and that she would be getting the best care.

“Dr. Ingham was phenomenal,” Shelby relates. “He made diagrams and talked in normal terms that we could understand. He believed he could do the partial, but made it clear he might have to take the whole kidney. If it wasn’t Dr. Ingham, I wouldn’t have been as quick to say yes. It was just the way he talked to us… he took his time and listened to my concerns. I said, ‘Do what you have to do.’”

Dr. Ingham recommended surgery for Shelby because she was young and otherwise healthy. “The other option for a mass of that size is active surveillance which involves a biopsy up front and typically scans every six months to make sure it is not showing signs of growing more aggressive,” he explains. “We tend to do that more in older patients who are less healthy.”

Because the mass was in the center of her kidney, Dr. Ingham estimates there was a 60-40 chance he would have to remove the entire organ. He wouldn’t know until the surgery whether he could do the partial nephrectomy.

“It depends on the size of the mass, where it is on the kidney, and how the other kidney looks,” notes Dr. Ingham. “We try to just take out the bad part if we can. As long as you can remove the entire mass and the margins are negative, the long-term cancer outcomes between removing part of the kidney and all of it tend to be the same. Two-and-a-half to three centimeters is a reasonable size to do a partial nephrectomy, but having the mass in the middle can make it more difficult as you have to cut deeper into the kidney.”

Sitting at the da Vinci Xi® console with a magnified, high-resolution, 3-D image viewfinder, Dr. Ingham performed Shelby’s surgery through small incisions with robotic arms that translated his hand motions into finer and more precise actions. Once inside, the news was good; it appeared Shelby only needed a partial nephrectomy. Reconstruction of the kidney then became an important part of the surgery.

“Once you cut out the mass, you have a big crater in the surface of the kidney, so you need to bring it back together,” explains Dr. Ingham. “Sometimes we’ll take five to10 percent of the kidney, if the mass is on the outskirts. If the mass is deeper, like Shelby’s, we might take 20 percent. You stitch it up and ensure the stitches are tight. Then we take the clamps off the blood vessels and watch it for a while to make sure nothing is bleeding.”

“A patient can generally do okay with one kidney, but you have lost your reserve,” Dr. Ingham states. “That’s the reason we try to do a partial if we can. It’s certainly better to have more kidney than less. If I take out the whole kidney, I’ll have the patient meet with a nephrologist to discuss ways to keep the remaining kidney as healthy as possible.”

After Shelby’s surgery, Dr. Ingham sent out the mass for a biopsy. Meanwhile, Shelby stayed overnight at Milford Regional and returned home with orders to avoid strenuous activities for four to six weeks. “The hospital staff was fantastic,” Shelby notes. “Before the surgery, every single person who was involved in it came in and told me what their role was and what to expect, everyone, from anesthesia to the nurses. That was pretty incredible. When I was recovering, it was nice that I had a private room. I never felt like I was putting the nurses out.”

Once Shelby was home, she found Dr. Ingham to be very responsive to her phone calls. “When I did have a question after I got home, Dr. Ingham called me back directly, which was great. Dr. Ingham actually stayed late at the office and waited for my husband to show up so he could pick up a prescription that had to be handwritten. He’s the type of doctor that goes above and beyond.”

To Shelby’s relief, the mass was diagnosed as an oncocytoma, a benign tumor of the kidney impossible to distinguish from a cancerous tumor without surgery. Dr. Ingham says it probably wouldn’t have caused her symptoms but that it would have resulted in years of imaging to monitor its growth.

According to Dr. Ingham, most kidney masses are found incidentally on scans for unrelated issues. “Kidney cancer often has no symptoms,” says Dr. Ingham. “When the mass gets larger, the patient can have discomfort, feel fullness in the abdomen or see blood in the urine, but most feel fine. Unless it is a higher stage, most kidney cancers don’t need other treatment after surgery. We just watch it to make sure it doesn’t come back. Shelby’s follow-up will be a lot less involved than someone who had kidney cancer.”

Shelby admits that although she was thrilled with the biopsy news, it shocked her that she beat the odds. She had prepared herself for the worst while hoping for the best. “I’m a prime example that things can go right,” she says. “You don’t have to go into Boston to find top notch doctors. They’re right in our backyard.”

Read more about Matthew Ingham, MD, Urology Associates of Milford.

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