Precision in Action: Robotic Surgery for Complex Renal Cancer By Dr. Karthik Rao

Introduction

Renal cell carcinoma (RCC) is one of the most challenging urological cancers, particularly when it presents with aggressive histological variants or metastatic disease. Advances in targeted therapy and immunotherapy have improved survival, but in selected cases, surgery remains a cornerstone of management. The robotic platform has further enhanced surgical precision, especially in kidney-preserving procedures.

Case Highlight

A 45-year-old woman with a history of hypothyroidism and metastatic renal cell carcinoma (rhabdoid + sarcomatoid, CD10 and PAX8 positive, IMDC intermediate risk).

Prior treatments included:

• 8 cycles of pembrolizumab + lenvatinib
• SBRT (Feb–July 2023)
• 4 cycles of nivolumab + ipilimumab
• 35 cycles of nivolumab (last dose: July 27, 2025)

Clinical Evaluation:

• DTPA Renogram: Right kidney function 47% (normalized GFR 51 ml); Left kidney function 53% (normalized GFR 57 ml).
• FDG PET: Enhancing lesion at medial interpolar cortex of right kidney, 22 × 25 × 30 mm, SUV 3.4.
• Right renal vein patent; single right renal artery.

Surgical Journey

After multidisciplinary discussion, the patient underwent:

• Cystoscopy with right DJ stenting
• Robot-assisted right partial/radical nephrectomy

The robotic platform enabled meticulous dissection around the tumour and renal vessels, ensuring safe resection with minimal morbidity.

Outcome

• The procedure was successful.
• The patient had an uneventful recovery and was discharged in stable condition.
• Postoperative follow-up continues under a combined oncology and urology care plan.

Discussion

This case underscores several important points:

• Advanced RCC often requires multimodal management, including immunotherapy, radiation, and surgery.
• Robotic surgery provides a valuable option in complex renal tumours, especially when aiming to preserve renal function while achieving oncological clearance.
• Careful patient selection, imaging, and preoperative planning (including renal function studies and vascular mapping) are critical to outcomes.

Conclusion

For patients with advanced or complex renal cell carcinoma, robot-assisted surgery offers precision, safety, and improved recovery, even after multiple lines of prior therapy. At Fortis Hospital, Bannerghatta Road, the integration of robotics with multidisciplinary expertise continues to redefine possibilities in advanced urological cancer car