Surgeons at Hartford Hospital were instrumental in developing many of the minimally invasive techniques now in use for kidney surgery.
Surgery is the only way to cure kidney cancer. The number of renal tumors being diagnosed is on the rise because improved imaging technologies allow earlier detection. Recent advances in surgical techniques allow surgeons to frequently remove only the tumor from the kidney - partial nephrectomy or nephron-sparing surgery (NSS). Nephron-sparing surgery allows preservation of the majority of the affected kidney without compromising cancer cure rates. “Leaving the patient with more kidney function, dramatically improves their overall health and well being, and reduces the incidence of chronic kidney disease (CKD).”
David Hull, MD (deceased), former director of the hospital’s Transplant Program
, led the region in laparoscopic removal of a donor kidney.
In 1998, Dr. Shichman pioneered the hand-assisted laparoscopic nephrectomy (HALN), which is now one of the gold standards in minimally invasive nephrectomy. He has taught the technique to well over 1,000 surgeons from the U.S. and overseas as an instructor and director of American Urological Association (AUA) post-graduate courses.
The percentage of kidney cancer surgery being performed laparoscopically, rather than open, has grown dramatically since Dr. Shichman introduced the HALN technique. Compared to the 1990’s, when almost all patients with kidney tumors had their entire kidney removed through a large and painful incision, well over 90% of all patients with kidney tumors are now treated using a minimally invasive surgical approach.
Additionally, the percentage of patients undergoing partial nephrectomies has grown dramatically in the past five years. Sixty percent of all patients coming to Hartford Hospital for their kidney cancer surgery now undergo nephron-sparing surgery.
In another advance, Dr. Shichman and a Connecticut Surgical Group colleague, Stuart Kesler MD
, are now among the world's most experienced in performing robotic partial nephrectomies. This new procedure allows even more complex and larger tumors to be removed using a minimally invasive approach. Dr Shichman is the Co-director of the upcoming AUA course teaching kidney robotic surgery.
During 2008, Dr. Shichman performed 150 kidney surgeries—more than any other surgeon in the region—and more than 80 percent of them were done minimally invasively. Patients go home two or three days after surgery, instead of five or six, and experience less pain. They typically return to baseline activity in two weeks, rather than the six to eight weeks associated with open surgery.
Hartford Hospital is a recognized center of excellence in kidney transplantation. Half of all kidneys donated in the U.S. are from live volunteer donors. Removing the organ intact and able to be implanted is extremely exacting. With open surgery, the recovery period for donors used to be long and difficult— much worse than that of the recipient. But with the use of the hand-assisted laparoscopic approach, donors are in the hospital for only three and a half days, on average, rather than two weeks, and are able to return to normal activities sooner.
Dr. Shichman says that few hospitals in the country are as innovative as Hartford Hospital in developing improved surgical procedures, and he attributes it to the quality of surgeons on staff, the sharing of knowledge across various surgical disciplines and the support of hospital administration. “We’re pushing the envelope, but in a safe, patient-oriented fashion,” notes Dr. Shichman. “While we are exceptionally progressive, we are also absolutely committed to doing what is best for each patient.”