In a rare surgical intervention, Meenakshi Mission Hospital and Research Centre (MMHRC) successfully performed two complex surgeries in a single sitting on a 51-year-old male patient to remove a cancerous tumour from his right kidney and a stone from his left kidney. The procedures performed were a robot-assisted laparoscopic partial nephrectomy to remove the kidney tumour while preserving healthy kidney tissue, and Retrograde Intrarenal Surgery (RIRS), a minimally invasive procedure to remove the kidney stone.
The patient was found to have a 3.8 × 3.3 cm tumour in the mid-pole region of the right kidney. He was also diagnosed with a 1.2 cm kidney stone in the left kidney. The partial nephrectomy was particularly challenging because of several anatomical and tumour-related factors. A large part of the tumour was located within the kidney (endophytic), rather than projecting outward from the kidney’s surface. This required highly precise dissection to completely remove the tumour.
Adding to the complexity, the tumour was located close to the pelvicalyceal system, the network within the kidney that collects urine before it passes into the ureter, and in close proximity to the renal hilum, where the kidney’s major blood vessels and ureter enter and leave the organ. The surgery therefore required careful dissection to avoid injury to the vital structures at the renal hilum.
The patient also had complex renal vascular anatomy, with three renal arteries supplying the right kidney rather than the usual single main renal artery. This further increased the technical demands of the procedure, as the surgeons had to carefully identify and preserve the blood supply to the healthy portion of the kidney while achieving complete removal of the tumour.
Following the procedures, the tumour was completely removed with clear surgical margins, indicating that no cancerous cells were present at the edges of the removed tissue. The kidney stone was also successfully removed. The patient recovered well and was discharged four days after the procedures.
The procedures were performed by Dr. Paul Vincent, Senior Consultant - Urologist & Andrologist, with the support of Dr. Ravichandran, Senior Consultant & HOD - Urology, Dr Venugopal Konanki, Consultant Urologist, Dr Ranjith Mahadevan, Associate Consultant Urologist, and Dr Kannan, Senior Consultant Anaesthetist.
In his comments, Dr. Paul Vincent, Senior Consultant - Urologist & Andrologist said, “The robotic-assisted laparoscopic approach enabled us to perform the tumour removal with precision through a minimally invasive technique, offering the patient the benefits of reduced blood loss and post-operative pain, faster recovery and a shorter hospital stay. Performing RIRS for the left kidney stone in the same sitting allowed us to treat both conditions without subjecting the patient to a separate procedure and hospitalisation. Such complex minimally invasive surgery requires advanced urological expertise, appropriate technology, a skilled anaesthesia team and comprehensive post-operative care.”
He added that radical nephrectomy involves removal of the entire kidney and is generally considered for larger or more advanced kidney tumours, including tumours exceeding 7 cm or those involving critical structures such as the pelvicalyceal system, surrounding tissues or the adrenal gland. In contrast, partial nephrectomy removes only the tumour along with a small margin of surrounding tissues, preserving the remaining healthy kidney. For localised renal tumours measuring less than 7 cm, partial nephrectomy can provide comparable oncological outcomes to radical nephrectomy when the tumour is completely removed with clear margins, while preserving greater renal function in the long term.
Dr. Ravichandran, Senior Consultant & HOD - Urology commented: “Partial nephrectomy, or nephron-sparing surgery, is a demanding procedure, particularly when the tumour is located close to critical structures. However, even in complex tumour situations, a minimally invasive robotic or laparoscopic approach is technically feasible and, when performed by an experienced surgical team, can be carried out safely. Whenever clinically appropriate, every effort should be made to preserve the maximum amount of healthy kidney tissue and maintain the patient’s renal reserve in the long term. For localised renal tumours, radical nephrectomy should not be chosen simply because removing the entire kidney is technically more straightforward when a kidney-sparing approach is feasible.”
Dr. Paul Vincent, Senior Consultant - Urologist & Andrologist also added that, “In this patient, we were able to successfully perform the complex partial nephrectomy and, during the same sitting, treat the 1.2 cm stone in the opposite kidney using RIRS. This minimally invasive procedure involves passing a flexible ureteroscope through the natural urinary passage into the kidney, allowing the stone to be directly visualised and fragmented using a laser, without any external incision. Addressing both conditions in a single sitting spared the patient the need for a separate procedure and hospitalisation.”
At this press conference, Meenakshi Mission Hospital’s Medical Administrator Dr. B. Kannan was also present.