"This case reflects the very essence of multidisciplinary, high-precision care," said Dr D Nageshwar Reddy, Chairman, AIG Hospitals.
Published May 11, 2025 | 9:32 AM ⚊ Updated May 11, 2025 | 9:34 AM
First robotic retroperitoneal partial nephrectomy in Telugu states. (Supplied)
Synopsis: Doctors at AIG Hospitals, Hyderabad, performed Telangana and Andhra Pradesh’s first robotic retroperitoneal partial nephrectomy on a liver-disease patient. Avoiding the risky abdominal route, they accessed the kidney from the side, preserving organ function and minimizing complications. Using robotic precision and intraoperative ultrasound, the tumour was safely removed, with minimal pain and a quick 48-hour recovery.
When surgery through the front door of the body was too risky, doctors at AIG Hospitals in Hyderabad chose a different path—through the side.
In a rare and complex procedure, they performed the first robotic retroperitoneal partial nephrectomy—removing only the part of the kidney that has the tumour, instead of removing the whole kidney— in Telangana and Andhra Pradesh on a patient with serious liver disease.
The patient, a 45-year-old woman with a known history of CLD and ascites (a condition where fluid builds up in the belly), came to the hospital with symptoms including right flank pain, persistent fatigue, and generalized weakness.
After a detailed evaluation, including a high-resolution contrast-enhanced CT scan, doctors found a 4 cm x 4 cm cancerous tumour in her right kidney. The tumour was pressing against the kidney’s functional tissue, impairing the organ’s ability to filter blood, remove waste, and produce urine.
To make things more challenging, the patient also had a 5 cm enlarged liver (hepatomegaly) and moderate ascites, complicating any surgical approach. Conventional surgery was considered too risky because of the severe anatomical constraints caused by her condition.
The usual way would have meant moving around the intestines and liver, which could cause major complications. So the medical team took the retroperitoneal route—a side entry to the kidney that avoids touching the main organs inside the abdomen.
This method, although more intricate, allowed the surgical team to operate in a confined space without disturbing the liver and intestines. Using advanced robotic technology, the team was able to remove the tumor while protecting the surrounding organs. They also used a robot-controlled ultrasound probe during the operation to ensure they removed only the tumor and preserved as much healthy kidney tissue as possible.
“The conventional transperitoneal (abdominal) laparoscopic or robotic route was ruled out due to ascitic fluid, fragile liver architecture, and risk to surrounding intestinal structures,” explained Dr Bipin Chandra Pal Director and HOD of Urology and Renal Transplantation at AIG Hospitals.
“We decided to use the retroperitoneal approach, a far more intricate but targeted route that avoids entry into the abdominal cavity altogether. This approach represents a significant advancement for patients who were previously considered high-risk or inoperable,” Dr Bipin added.
Adding to the complexity of the case due to the existing Chronic Liver Disease, Dr Mithun Sharma, Director and HOD, Hepatology, AIG Hospitals said, “The patient is suffering with liver cirrhosis, a serious condition where the liver is permanently damaged. People with cirrhosis face much higher risks during surgery, including complications, infections, and slower recovery.”
“The robotic retroperitoneal approach allows the surgeon to operate with minimal invasion without entering the main abdominal cavity. This helps prevent fluid leakage (ascites), lowers the risk of infection in the abdomen (peritonitis), and avoids sudden changes in blood flow that can worsen liver-related issues like portal hypertension. Overall, this approach makes surgery much safer for patients with advanced liver disease.”
“This case reflects the very essence of multidisciplinary, high-precision care,” said Dr D Nageshwar Reddy, Chairman, AIG Hospitals.
“A patient with chronic liver disease and a complex renal tumour would traditionally face prolonged hospitalization and elevated surgical risk. But with advanced planning and integration between hepatologists, urologists, radiologists, and anesthetists, we were able to achieve an organ-preserving, minimally invasive outcome that dramatically shortened recovery time.”
To begin, intraoperative ultrasound was introduced via a robotic drop-in probe to delineate the tumour’s boundary in real time. This step ensured maximum preservation of healthy kidney tissue and reduced the risk of positive surgical margins. Once marked, the robotic arms delicately removed the tumour followed by the repair of the kidney.
Post-operatively, the patient experienced minimal pain, no complications, and was discharged within 48 hours, a rarity in such high-risk liver-disease cases. Renal function was preserved, and the pathology confirmed complete tumor removal.
(Edited by Sumavarsha)
