NAPLES — Hershell Stalling figured he would wait a while longer to see what would happen to a growth on his kidney.
After all, an MRI had shown the tumor had grown about one inch between 2003 and 2009 when a first scan detected it.
Now, he’s pleased he had a change of heart and underwent surgery Sept. 29 for partial kidney removal, a partial nephrectomy, where the surgeon used the da Vinci robotic system to remove the tumor. It did turn out to be cancerous.
The 59-year-old Golden Gate Estates resident was among the first patients at Physicians Regional Medical Center at Pine Ridge to have the kidney surgery with the robotic system. Dr. Michael D’Angelo, a urologist who specializes in minimally-invasive surgery and robotic surgery, did the procedure.
“I was kind of leery,” Stalling said. “Luckily he removed it and it was cancer and he got it all out.”
The semi-retired crane business owner was released from the hospital the day after the surgery.
“I was out the next day and walking around,” Stalling said.
D’Angelo, who is with Specialists in Urology, has used the da Vinci to perform the same kidney surgery on one other patient, and he has two more cases scheduled over the next month at Physicians Regional.
The advantage with using the robot, as opposed to laparoscopic or minimally-invasive surgery, is the greatly enhanced viewing field. The technology involves a console where the surgeon sits and leans forward into a headrest that provides a multi-dimensional view of the surgical field. The surgeon uses each forefinger and thumb to maneuver scissor-like hand controls as the robotic arms. The imaging is three dimensional with the da Vinci as opposed to two dimensional with laproscopic equipment.
“And it magnifies my visual (field) 10 times,” D’Angelo said. “You see everything, every blood vessel.”
D’Angelo said he is the first surgeon in Collier County to use the da Vinci to remove small- or mediam-size kidney tumors, yet another surgeon, new to the area, has just started to do the same procedure at NCH Downtown Naples Hospital.
Dr. David Ornstein relocated to Naples in August from the University of California, Irvine, and was medical director of Robotic Surgery and Urologic Oncology at the Todd Cancer Institute, Long Beach Memorial Medical Center in Long Beach.
“I’ve done about 15 (robotic partial nephrectomies) out in California and we published a paper,” he said. “The robot makes it easier for the surgeon to do it. It makes the surgeon’s motions more precise.”
Some studies have shown that 70 percent to 80 percent of renal tumors should be addressed by a partial nephrectomy but in the United States, 30 percent of cases are treated by removing the kidney, a total nephrectomy, he said. The reason being a partial is more difficult than taking out the whole kidney, Ornstein said.
Another advantage with the improved visual field with the da Vinci is more precise targeting of the cancerous tumor and sparing healthy tissue, D’Angelo said. Moreover, there is less blood loss. After removing the tumor, the kidney needs to be stitched up.
Patients experience a much shorter hospital stay with robotic and laparoscopic surgery with less pain. Only small incisions are made.
With traditional “open” kidney surgery, the patient faces a 12-inch incision across the midsection and stays in the hospital at least five days, and possibly seven days. Now with laparoscopic or robotic surgery, they are discharged the next day or second day.
“It’s night and day difference for the patients,” D’Angelo said.
The ideal patients for robotic partial nephrectomy are those whose tumors are small or medium, so an inch to three inches in size, he said. Others who have kidney dysfunction also are candidates, he said.
Stalling, one of his recent patients, said D’Angelo explained every thing ahead of time and that was a help.
“If they have any doubts, they need to see him,” Stalling said. “He explains it you and what he says is pretty much gospel.”