Single-Incision Robotic Surgery (SIRS) for Large Kidney Tumors


Aug. 18, 2008 — Siteman Cancer Center urologist Sam Bhayani, MD, discusses a new application for a procedure called single-incision robotic surgery or SIRS. Bhayani has just begun using the technique to remove large kidney tumors in cancer patients, resulting in less scarring and faster recovery times.

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On this edition of Cancer Connection, we’ll talk about single-incision robotic surgery and how single incisions through the belly button offer fewer scars and a quicker recovery.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St Louis. I’m Jason Merrill. Imagine cancer surgery with barely a scar to show for it. On Aug. 1, Washington University surgeons at Barnes Jewish Hospital removed a kidney cancer through a single incision in the patient’s belly button. Dr. Sam Bhayani and his colleagues have been removing small tumors laparoscopically for about a year, and while for small tumors Bhayani will continue to perform the procedure robotically with four to five small incisions, for large tumors, this is a new approach. To tell us more about it is Sam Bhayani. He is a urologic surgeon at the Siteman Cancer Center. Dr. Bhayani, thank you for joining us.

Bhayani: Thank you for having me.

Host: So talk about the new procedure. What were you able to do?

Bhayani: We removed a patient’s kidney cancer, an incredibly large tumor over 6½ inches big, through the patient’s belly button, and we did it robotically. This is being referred to as single-incision robotic surgery. S  I  R  S would be the acronym, or SIRS is what we call it. Basically, we were able to remove a large kidney tumor – an extremely large kidney tumor – through a patient’s belly button through one small incision, and there were really no problems during the operation. The operation took about two and half hours. She only lost a minimal amount of blood, and I expect her to go home in a day or two.

The reason this surgery is revolutionary is because traditionally patients would get a very large incision on their side for a tumor this large, a 12-centimeter incision. Even doing it laparoscopically, she would end up with four or five little laparoscopic incisions in addition to the incision to take it out of the body. And we were able to remove the tumor through about a 3½-inch incision right at her belly button.

Host: How does that differ from a traditional procedure?

Bhayani: Well, there are basically two traditional procedures. One would be an open surgery. That would be a large incision on the side that’s about a foot long, and that would involve taking out a rib, going through her muscles and taking out the kidney on the side of the body. That operation takes about the same amount of time, maybe a little longer, and that operation would mean about a week in the hospital and about two months recovery time.

Another operation would be to do this laparoscopically. Laparoscopic surgery would involve five to six or four to five small incisions plus an incision to get it out of the body. That operation would take about three to four hours, and that would result in about a three-day stay in the hospital. So this was faster. It was done with fewer incisions – basically one incision. We pulled it out through her belly button, and I think she’s going to have a great result. I expect her to be cured.

Host: The da Vinci device that you used to perform this, that really made the difference in this being a possibility, correct?

Bhayani: Absolutely. People have done single-port or single-incision surgery laparoscopically, but those are for very small kidneys, such as a patient who wants to donate a kidney to somebody else. Those kidneys don’t have large tumors in them, so it’s very easy to get around those kidneys. For kidney cancer and tumors that are large, the robot allows me to get around the kidney with all the mobility I need, despite having just this tiny incision at the belly button.

The way it works is we put the robot instruments through the belly button, and we operate around the kidney to release the whole cancer and get it out of the body. I believe this is the largest kidney cancer that’s ever been removed with this single-incision technique, and certainly we’re able to do it robotically. Now Barnes Hospital and the Siteman Cancer Center and Washington University have been leaders in robotic kidney surgery. We pioneered the procedure for small tumors and big tumors, and now we’re pioneering it for removal of tumors with just an incision right at the belly button. It’s tremendously exciting to be part of it.

Host: What are the benefits to a patient to just have that one incision?

Bhayani: Well there are a lot of benefits. One benefit is fewer scars. Less pain. Taking it out through the belly button is cosmetically better for the patient, and I expect her to have a quicker recovery time as well.

Host: Talk about how this procedure works versus laparoscopically. With a regular surgery, you would be right by the bed, right by patients, as they’re being operated on. In this case, you’re at a machine nearby.

Bhayani: Right. So I place three robotic instruments through the patient’s belly button, and then I sit at a machine that controls the robot to do the operation. Now it’s important to point out the robot is not doing the operation. I’m literally controlling it to do every move. My robotic instruments are like having hands inside the body, and having those hands inside the body is a tremendous advance.

Now people have removed kidneys robotically, but that’s also traditionally done with four or five incisions on the patient’s body. Again, the advance here is we were able to remove really a huge kidney tumor through just basically the belly button. So we’ve taken it one step further, and that one step is a move toward a minimally invasive surgery. Eventually, it’ll be a surgery without incisions. So we’re well on that goal to benefit our patients and to still treat them with the appropriate cancer surgery.

Host: If I’m a patient and I’ve been diagnosed with kidney cancer and I hear I can have surgery like this, I would very much be interested in it. Is everyone a candidate?

Bhayani: Not everybody’s a candidate. I think the size of the tumor is an important issue and also the location of the tumor within the kidney. Nevertheless, we seem to really be pushing the envelope by doing a tumor that’s 12 centimeters in size. I’d say that encompasses 99 percent of tumors. So you know, I really think that we’ve made an advance here that we’re going to be able to do this in most kidney tumors. But experience counts, and I think it’s important to go to a very experienced kidney surgeon to do these operations. This is not going to be something that’s offered in every hospital in the country. It really requires specialized equipment, a lot of training and a great team, and we’re lucky to have that team here at Barnes Hospital.

Host: So this is the first one you have under your belt. How common do you think this is going to be in your practice?

Bhayani: I think this is going to end up being the standard of care to remove kidney tumors. I can’t imagine making four incisions when we can take it out through the belly button. It just seems to be such a great advance and seems to be great for patients. I think if you ask patients if they could have four or five incisions or one small incision, they’re going to pick the one small one.

Host: Dr. Bhayani, thanks for joining us.

Bhayani: Thank you.

Host: For more information about kidney cancer, you can visit the Siteman Cancer Center online at or call 800-600-3606. Thanks for downloading. Until next time, I’m Jason Merrill.