Saving Critical Surgical Minutes

Kidney cancer tumor surgery has new FAST method

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Blood flow to the kidney has to be stopped while a cancer tumor is being removed. And those minutes are critical. So kidney cancer surgery involves a race against time.

A new type of robot-assisted cancer surgery greatly reduces the time the kidney doesn’t have blood flow.

This new technique is called first assistant sparing technique  - or FAST - and is being used to remove kidney tumors.

"Learn the details of any surgery."

Ketan K. Badani, MD, chief of robotic and minimally invasive surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center led the study that examined this new surgical technique.

"By incorporating FAST into our robotic approach, for the first time we were able to cut WIT down to an average of 15 minutes - and 18 minutes for more complicated tumors," said Dr. Badani, an associate professor of urology at Columbia University College of Physicians and Surgeons.

WIT stands for warm ischemia time, which describes when the kidney doesn’t have blood flow. And the surgery to remove a kidney tumor is called a partial nephrectomy. The operation involves taking out the tumor, while preserving the kidney.

“As a rule of thumb," said Dr. Badani, "the maximum time blood flow can be cut off from the kidney is 30 minutes, to avoid irreversible damage. But studies suggest that every minute blood flow to the kidney is blocked can have a cumulative effect on kidney function."

Dr. Badani and his colleagues at New York-Presbyterian reviewed and compared the FAST technique with standard robot-assisted surgery. The small study involved 44 patients.

The new approach was just as efficient as the standard in removing the tumor and leaving clean (cancer-free) margins while also reducing WIT.

dailyRx News asked Dr. Badani to give us some history about these surgeries.

“Robotic partial nephrectomy has been around since 2005, but really started becoming a popular approach over the last 4-5 years," he told dailyRx.

"Robotic partial nephrectomy has shown to lower blood loss, shorten recovery, and shorten ischemia [restricted blood flow] over laparoscopic partial. This technique is a further modification of robotic partial to further decrease ishchemia time,” Dr. Badani said.

dailyRx asked about the differences in prices between the newer surgical technique and the standard method.

“Generally speaking, robotic surgery costs around $800-1000 more than laparoscopic partial, but that cost is not transferred to insurance or patient, the hospital swallows that difference,” Dr. Badani said.

“So as far as the patient or his/her insurance is concerned, there is no difference. When comparing FAST to standard robotic partial, there is no cost difference.”

The technique collapses a number of tasks that had been performed by surgical assistants.

This study was published in the June issue of Journal of Endourology.

No financial information was publicly available.

Reviewed by: 
Review Date: 
September 17, 2012
Last Updated:
September 18, 2012