Fred Hutchinson Cancer Center recently became one of only a few centers in the Pacific Northwest to acquire the da Vinci single-port robotic surgical system. Adding this new technology to its fleet of surgical tools represents Fred Hutch's commitment to innovation and providing the highest level of care.
The single-port robotic surgeries take place at UW Medical Center-Montlake. With one small incision, the single-port system can reach tighter spaces using a narrower entry pathway than previously possible. This precision is particularly helpful in the treatment of complex urologic cancers of the kidney, urinary tract and adrenal gland.
“There is growing incidence of kidney cancer in the U.S. due in part to incidental detection on cross-sectional imaging tests ordered to diagnose other health problems. Between 2009 and 2018, rates increased by about 1% per year,” says Fred Hutch urologist and genitourinary cancer specialist, John L. Gore, MD, MS, FACS. “Considering many patients with kidney cancer are older, the single-port robot often gives us a better option for minimally invasive surgery.”
Leading-Edge Technology for Urologic Cancer Surgery
The da Vinci single-port robot represents one of the latest advancements in robotic surgical technology. Dr. Gore currently uses the single-port system for:
- Retroperitoneal and transperitoneal partial nephrectomy to resect a kidney tumor
- Nephroureterectomy to remove the kidney and ureter
- Adrenal surgery to remove a cancerous tumor or a tumor that is producing excess hormones
Other specialists at Fred Hutch use the da Vinci single-port robot to perform:
- Head and neck cancer surgery
- Prostatectomy
Benefits of Single-Port Robotic Surgery
The single-port robot contains an endoscope and three instruments in a single 2.4 cm diameter cannula with a 24 cm depth of reach. The benefits of this technology are fourfold:
1. Facilitates Access to Small Spaces
Kidney surgery often requires a retroperitoneal approach. “With the multiport robot, we use a balloon to open up the retroperitoneal space and make room for the larger instruments,” says Dr. Gore. “The single port allows easier access to the tight space without the need to make additional space for the other instruments. It also reduces the amount of dissection needed to access the kidney.”
2. Navigates Around Challenging Anatomical Areas
Multi-port robots require four small incisions and triangulation of instruments toward the target area. With the single-port robot, the surgeon makes a single one-inch incision and uses one narrow pathway.
This provides a safer approach in patients with scar tissue from past surgeries, among other benefits. “Rather than having to navigate the scar tissue with four instruments, we only need to find one safe route in,” says Dr. Gore.
3. Reaches Deeper into the Abdomen
Surgeries such as nephroureterectomies span the upper and lower abdomen. Because instruments on the single-port robot are fully wristed and elbowed, they provide a swivel capability. Swiveling the instruments allows the surgeon to access the kidney, then follow the ureter to the bladder without changing orientation.
4. Improves Patient Outcomes
Robotic, minimally invasive surgery generally offers a faster recovery compared with traditional open surgery. Early evidence suggests single-port robotic surgery may further improve recovery over multi-port surgery.
A study published in 2020 compared post-operative outcomes between patients who underwent single-port (n=50) and multi-port (n=113) robotic radical prostatectomies. The researchers found that patients in the single-port cohort:
- Were more likely to be pain-free on the first postoperative day
- Spent one less day in the hospital
Choosing the Right Approach
Surgery is the most common treatment for patients with localized renal masses, upper urinary tract cancers and adrenal tumors.
At Fred Hutch, surgeons use open and minimally invasive options to treat urologic cancer. They evaluate each patient individually to determine the most appropriate strategy. That’s where experience comes in.
As a surgeon-scientist, Dr. Gore may recommend open surgery over robotic surgery in patients with:
- Multiple tumors: These may be easier to resect using an open procedure
- One kidney: Open surgery can help minimize ischemia to the solitary kidney
- Past surgeries: Open surgery may be safer if there is significant scar tissue left over from previous procedures
Dr. Gore and his colleagues have experience treating all types of urologic cancers. “At Fred Hutch, we have all options available and the expertise to choose what’s best,” he says.
Urologic Cancer Referrals at Fred Hutch
Fred Hutch physicians provide consultations and care coordination in partnership with community oncologists to discuss treatment options and opportunities for collaborative care.
For patient referrals contact:
- Phone: (206) 606-8300
- Fax: (206) 606-2216
- Email: pccgu@fredhutch.org
- Online referral form
David’s number-one recommendation for other patients is to get digital scans when getting your eye tests – he credits the tests with discovering his small, 1.2 mm-diameter tumor, which otherwise may not have been found so early.
David also recommends that anyone diagnosed with ocular melanoma join the Facebook Ocular Melanoma group. “Members share their stories and what to expect. They are very helpful,” he says.
