Partial Nephrectomy	Radical Nephrectomy
Nephroureterectomy	Pyeloplasty

Almost all the development of Robotic surgery has been in pelvic cancer, either for removal of prostates (radical prostatectomy) or bladders (radical cystectomy). There has been almost no development in renal surgery apart from that of my unit at St George's hospital in London.

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  Partial Nephrectomy

I performed the first Robotic Partial Nephrectomy in the UK using a radiofrequency ablation assisted approach .I am alone amongst my peers in using this approach in which the Radiofrequency Ablation is applied to the tissue adjacent to the tumour. The result is that there is no clamping of blood vessels necessary thereby causing almost no loss of oxygen and therefore damage to the kidney. Blood loss is negligible and blood transfusion is rare. This technique will be published soon in peer review journals and hence a detailed description is not possible on the website yet.

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  Radical Nephrectomy

I have found that the greater maneuverability of the robotic instruments and the much greater magnification has proved very favourable in Robotic Nephrectomy. I therefore like to use this approach. However, the advantages are not as profound when comparing to Partial Nephrectomy and Pyeloplasty and hence I tend to decide whether to do the nephrectomy robotically versus laparoscopically on an individual and clinical basis.

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  Nephroureterectomy

In this operation the kidney, whole ureter and a cuff of bladder (into where the ureter inserts into the bladder) is removed. I have also started routinely using a robotic approach for this method. Due to anatomical considerations most laparoscopic surgeons remove the kidney with laparoscopy but remove the lower ureter with open surgery. This is where robotic surgery has the advantage as it is very feasible to perform the dissection of the lower ureter and bladder using the familiar approach that one is used to with pelvic surgeries like prostatectomy/cystectomy.

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  Pyeloplasty

This is reconstructive operation where the obstructed upper ureter is excised and opened up to facilitate free drainage of urine from the kidney. This is a benign condition where there is a narrowing in the upper ureter where it meets the kidney. Robotic surgery has proved to be ideal for this procedure as the surgery requires complex suturing, a maneuver which is made considerably easier and more precise with the articulation and magnification of the instruments.