Robotic partial nephrectomy
Keyhole surgery, done with a surgical robot, that cuts a tumor out of the kidney and sews the kidney closed, so you keep most of your kidney and its function.
Also called partial nephrectomy, RAPN, robot-assisted partial nephrectomy, robotic kidney tumor removal, nephron-sparing surgery, kidney-sparing surgery, NSS, laparoscopic partial nephrectomy
- Where
- Hospital operating room
- Anesthesia
- General anesthesia (you are fully asleep)
- Time in the room
- About 2 to 4 hours
- Hospital stay
- Usually 1 night, sometimes 2
- Back to normal
- About 2 to 4 weeks for most daily activities
- Back to work
- Desk work in 1 to 3 weeks; physical jobs in about 4 to 6 weeks
Overview
A partial nephrectomy removes a tumor from the kidney and leaves the rest of the kidney in place. Nephrectomy means removing a kidney; partial means only the part with the tumor. In the robotic method, your surgeon works through 4 to 6 small keyhole cuts and controls thin instruments from a console in the same room.
Most kidney tumors today are found by accident, on a scan done for something else, while they are still small. For tumors up to about 4 centimeters (about 1.5 inches), removing only the tumor controls the cancer about as well as removing the whole kidney, and it protects more of your long-term kidney function. The American Urological Association (AUA) and European Association of Urology (EAU) guidelines prefer partial nephrectomy for most small tumors when it can be done safely. Many tumors between 4 and 7 centimeters can also be treated this way.
The kidney is full of blood, so the hardest part of the operation is removing the tumor without heavy bleeding. Your surgeon often places a small clamp on the main kidney artery for a short time, usually under 25 minutes, cuts the tumor out with a thin rim of healthy tissue, and sews the kidney closed. Some tumors can be removed with no clamp at all.
Not every kidney mass is cancer. About 1 in 5 small, solid kidney masses turns out to be benign (not cancer) when the pathologist looks at it. When it is cancer, small kidney cancers that have not spread are cured by surgery in most people, and the follow-up plan is usually a scan once a year or so for several years.
The parts of your body involved
You have two kidneys, each about the size of your fist, tucked high in the back of your belly under the lower ribs, one on each side of the spine. They filter your blood and make urine. Each kidney is wrapped in a cushion of fat and a thin covering called Gerota's fascia. Blood comes in through the renal artery and leaves through the renal vein at the hilum, the kidney's doorway. Urine collects in small cups called calyces, drains into a funnel called the renal pelvis, and flows down the ureter, a thin tube, to the bladder. Most kidney cancers start in the outer layer of the kidney, the cortex, and grow outward like a bump on the surface.
- Cortex
The outer layer of the kidney, where most of the filtering happens. Most kidney cancers start here.
- Renal artery and vein
The main blood vessels at the kidney's doorway. The artery is the one your surgeon may clamp for a short time.
- Calyces and renal pelvis
The cups and funnel inside the kidney that collect urine. If the tumor sits close to them, your surgeon seals any small opening into them.
- Ureter
The thin tube that carries urine from the kidney down to the bladder. Your surgeon finds it early and protects it.
- Gerota's fat
The fatty layer around the kidney. The fat touching the tumor is removed with it so the pathologist can check it.
Why it’s done
Your urologist recommends this operation when a solid kidney mass is likely to be cancer and it can be removed while keeping a good amount of healthy kidney. The goals are to remove the tumor completely, learn exactly what it was, and protect your kidney function for the rest of your life.
- To remove a likely cancer
Most solid kidney masses that light up with contrast dye on a CT or MRI scan are cancer. Removing the tumor treats it and gives a firm answer.
- To protect kidney function
Keeping most of the kidney lowers the chance of chronic kidney disease later. This matters more if you have diabetes, high blood pressure, existing kidney disease, or a family history of kidney problems.
- Only one kidney, or tumors on both sides
If you have one kidney, or tumors in both kidneys, saving as much kidney as possible may be the only way to stay off dialysis.
- The tumor is growing
Some people start with watchful waiting. If the tumor grows quickly or reaches about 3 to 4 centimeters, surgery is often recommended.
- To know the exact type and grade
The pathology report tells you the cancer type and grade, which sets your follow-up plan and whether any further treatment is worth discussing.
Other options
- Active surveillance (watching with scans)
For small masses, usually under 2 to 3 centimeters, especially in older people or people with serious health problems, your team may watch the tumor with a scan every few months at first. Many small kidney tumors grow slowly, and the chance of spread while being watched is low. Treatment starts if it grows quickly or changes.
- Ablation (freezing or heating the tumor)
Thin needles placed through the skin freeze or heat the tumor. It works best for tumors up to about 3 centimeters. Recovery is faster, but the chance the tumor comes back in the same spot is somewhat higher than with surgery, and a second treatment is sometimes needed.
- Removing the whole kidney (radical nephrectomy)
For large tumors, tumors deep in the center of the kidney, or when a partial would not be safe, removing the whole kidney may be the better choice. Most people live normally with one healthy kidney.
- Open or laparoscopic partial nephrectomy
The same operation can be done through a larger cut on the side (open) or with standard laparoscopic instruments. Open surgery is still used for some very complex tumors. Robotic surgery usually means less pain and a shorter hospital stay.
- A biopsy first
A needle biopsy can show whether the mass is cancer and what type it is before you decide. It is most helpful when the result would change your choice, such as between surgery and watching.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
2 to 4 weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and lying on your side
The anesthesia team gives medicine through your IV so you fall fully asleep, then places a breathing tube. You are turned onto your side with the tumor side up, and the table is bent slightly at the waist to open the space between your ribs and hip. Soft pads protect your arms, hips and legs. A catheter, a thin tube to drain urine, is placed in your bladder after you are asleep.
More detail
Most surgeons use a tilted side position for the approach through the belly (transperitoneal), or a fully sideways position for the approach from the back (retroperitoneal). You also get an antibiotic through the IV shortly before the first cut.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
You wake in the recovery room with a catheter in your bladder, an IV, and squeezing sleeves on your legs. You may have a drain on your side. Most people are drowsy for a few hours.
- Pain control
Most pain is managed with scheduled acetaminophen and other non-opioid medicines, with a small amount of opioid medicine only if needed. Many teams limit ibuprofen-type medicines after kidney surgery to protect the kidney.
- Walking
Nurses help you sit up and walk the evening of surgery or the next morning. Walking early lowers the risk of blood clots and pneumonia and helps the bowels wake up.
- Breathing exercises
You may be given a small plastic breathing device (incentive spirometer) to use several times an hour while awake.
- Eating and drinking
You can usually sip clear liquids the day of surgery and eat light food the next day.
- Blood tests
A blood count and creatinine are checked the next morning. A small rise in creatinine is common and usually settles.
- Tubes out and going home
The catheter usually comes out the next morning, and a drain, if used, before you leave. Most people go home after 1 night, sometimes 2.
At home
- Pain
Soreness at the cuts and a deep ache in the side are normal for 1 to 2 weeks. Take acetaminophen on a schedule as directed, and the stronger pain pill only if you need it. Ask before taking ibuprofen or naproxen.
- Incisions
Skin glue peels off on its own in 1 to 2 weeks. Do not scrub or pick at it. Some bruising around the cuts is common.
- Showering and bathing
You can usually shower after 24 to 48 hours; let soapy water run over the cuts and pat dry. Avoid baths, hot tubs and swimming for about 2 to 4 weeks, until the cuts are fully sealed.
- Urine
Light pink urine for a few days can be normal. Bright red urine or clots, especially if it starts after the urine had cleared, needs a call right away.
- Diet and fluids
Eat a normal, healthy diet. Drink enough that your urine stays pale yellow. You do not need a special kidney diet unless your doctor tells you otherwise.
- Bowels
Pain medicine and less movement can cause constipation. Use a stool softener while taking opioid pain pills. Many people have their first bowel movement 2 to 3 days after surgery.
- Activity and lifting
Walk several times a day and increase a little each day. Do not lift more than about 10 to 15 pounds (5 to 7 kilograms), and avoid hard exercise, for about 4 to 6 weeks. Your surgeon may allow sooner.
- Driving
Do not drive while taking opioid pain medicine. Most people can drive in 1 to 2 weeks, once they can turn and brake quickly without pain.
- Sex
You can usually return to sex when you feel comfortable, often after 2 to 3 weeks. Avoid positions that press on your belly or side at first.
- Work
Many people return to desk work in 1 to 3 weeks and to physical work in 4 to 6 weeks.
Recovery timeline
- Day of surgerySurgery and first walk
You wake in recovery, start sipping liquids, and usually sit up or walk that evening.
- Day 1 to 2Home
The catheter comes out, you eat and walk, and most people go home after 1 night.
- Week 1Rest and the pathology report
You tire easily and nap. The pathology report is often ready in about 1 week, and your team calls or schedules a visit to go over it.
- Weeks 2 to 3Getting back to routine
Pain is much less. Many people drive again and return to desk work.
- Weeks 4 to 6Back to full activity
Most lifting and exercise limits are lifted. Energy is close to normal.
- About 6 weeks to 3 monthsFollow-up visit
A check of your blood pressure, creatinine and recovery. Your team reviews the pathology plan.
- 3 to 12 monthsFirst follow-up scan
A CT or MRI of the belly is usually done within the first year to check the kidney, and the chest is checked on a schedule based on your risk.
- Years 1 to 5 and beyondOngoing checks
Scans and kidney function tests continue, often once a year, for several years. The schedule depends on the type, grade and stage of the tumor.
What it feels like
Most people say the waiting before surgery was harder than the recovery. Physically, the first few days bring soreness, tiredness, and some odd sensations like shoulder pain from the gas. Emotionally, the word cancer and the wait for the pathology report weigh heavily. Here is what people commonly describe, and what helps.
The days before surgery
Fear and restlessness are common, especially the night before. Many people worry about whether it is cancer, whether it has spread, and whether they will lose the whole kidney.
What helpsWrite down your questions and bring someone to the last visit. Ask your surgeon how likely it is that a partial can be done and what happens if it cannot. Knowing the plan for each possibility often makes the night before easier.
Waking up
You may feel groggy, chilly, and have a scratchy throat from the breathing tube. The bladder catheter can make you feel like you need to urinate even though the bladder is empty.
What helpsTell the nurse if you are in pain or feel sick to your stomach; there are medicines for both. The catheter feeling is normal and usually lasts only until the next morning.
The first day: shoulder pain
A sharp ache at the tip of one or both shoulders surprises many people. It comes from the leftover gas irritating the diaphragm, the breathing muscle under the ribs, which shares nerves with the shoulder.
What helpsWalking is the best cure. A warm pack on the shoulder and lying flat for a while also help. It usually fades in 1 to 3 days.
The first walk
Standing up for the first time can make you lightheaded, and the belly feels tight and sore when you straighten up.
What helpsSit on the edge of the bed for a minute first, and have a nurse beside you. Holding a pillow against your belly when you cough or stand eases the pull on the cuts.
The first week at home
Tiredness is often the biggest complaint, more than pain. Bloating, gas, and a slow return of the bowels are common.
What helpsPlan short walks several times a day and a nap. Eat small meals. Use a stool softener while on pain pills. Expect your energy to come back over 2 to 4 weeks.
Waiting for the pathology report
Days of waiting can feel long, and many people replay every worry.
What helpsAsk before you leave the hospital when and how you will get results. Remember that about 1 in 5 small kidney masses turns out not to be cancer, and that small cancers removed completely usually have an excellent outlook.
The first follow-up scan
Many people feel anxious in the days before each scan, sometimes called scanxiety.
What helpsAsk for the results visit to be scheduled soon after the scan. Over time, most people find that each normal scan makes the next one easier.
How well it works
Success means the tumor is fully removed, the pathologist confirms what it was, your kidney keeps working well, and follow-up scans stay clear. Most people return to their normal life with only a small change in kidney function.
- Clear margins
The pathology report says whether the edges of the removed tissue are free of tumor. A positive margin is uncommon and does not always mean cancer was left behind; most people with one are watched closely with scans rather than having more surgery.
- Type, grade and stage
The report names the tumor type (for example clear cell, papillary or chromophobe, or a benign tumor such as an oncocytoma), its grade (how aggressive the cells look), and its stage (size and whether it grew outside the kidney). Together these set your follow-up schedule.
- Kidney function
Your creatinine and eGFR (an estimate of how well your kidneys filter) are checked after surgery. Most people lose only a small part of their total kidney function after a partial nephrectomy.
- Follow-up scans
A CT or MRI is usually done within the first year, then on a schedule based on your risk, often yearly for several years.
- Further treatment, if needed
Most people need no more treatment. For a small number with high-risk features, your team may discuss a year of immunotherapy after surgery.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Soreness at the cuts and tiredness for 2 to 4 weeks are expected.
From leftover gas under the diaphragm. It usually fades in 1 to 3 days.
Light pink urine for a few days is common and usually clears on its own.
From anesthesia, pain medicine and less movement. It usually settles within a week.
A small rise in creatinine right after surgery is common. Most of it recovers.
Less common
Some people need a blood transfusion during or after surgery. Rates depend on tumor size and position and on surgeon experience.
If the urine-collecting system was opened, urine can leak from the repair. Most leaks heal on their own; some need a stent, a thin tube placed inside the ureter, or a drain.
A weak spot can form in a small artery inside the kidney and bleed days to weeks later, usually as sudden heavy blood in the urine. It is treated by blocking the vessel through a thin catheter passed from the groin (embolization).
Urinary infection, wound infection or pneumonia. Most are treated with antibiotics.
If the tumor cannot be safely removed alone, or bleeding cannot be controlled, the whole kidney may need to come out. Your surgeon will discuss your own chance before surgery.
Tumor cells at the edge of the removed tissue. It is usually watched with scans.
Rare
A clot in a leg vein that can travel to the lungs. Walking, leg sleeves and blood-thinner shots lower the risk.
The bowel, spleen, liver, pancreas, large blood vessels, or the lining of the lung can rarely be injured. Most injuries are seen and repaired during surgery.
Rarely, the surgeon needs to switch to a larger cut to finish the operation safely.
A bulge at one of the cuts, sometimes months later. It can be repaired.
Very rare in people with two healthy kidneys. The risk is higher if the operation is on a single kidney or if kidney function is already low.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Bright red urine or blood clots, especially if it starts after the urine had cleared (go to the emergency room if heavy)
- Feeling faint or dizzy, a racing heart, or new severe pain in the side or belly
- Unable to urinate for more than 6 to 8 hours
- Pain, swelling or redness in one calf, or chest pain or trouble breathing (call 911)
- Vomiting that will not stop, a swollen belly, or no gas or bowel movement for more than 3 days
- Redness spreading from a cut, pus, a cut that opens, or clear fluid steadily leaking from a cut or drain site
- Pain that your prescribed medicine does not control
Questions to ask your surgeon
- How large is my tumor, where is it, and how complex is it to remove?
- Do you think it is likely to be cancer? Would a biopsy change your advice?
- What is my chance of needing the whole kidney removed during surgery?
- Do you plan to clamp the artery, use a selective clamp, or go off-clamp, and why?
- Will you go through the belly or from the back?
- How many robotic partial nephrectomies do you do each year?
- How much of my kidney function do you expect me to lose?
- Will I have a drain or go home with any tubes?
- When will I get the pathology report, and who will explain it?
- What follow-up scans and blood tests will I need, and for how long?
- Should I see a genetic counselor?
- When can I return to work, exercise and lifting?
Words you may hear
- Pneumoperitoneum
- The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
- Partial nephrectomy
- Surgery that removes only the part of the kidney with the tumor.
- Renal cell carcinoma
- The most common type of kidney cancer, starting in the filtering tissue of the kidney.
- Small renal mass
- A kidney tumor about 4 centimeters or smaller, often found by accident on a scan.
- Hilum
- The kidney's doorway, where the artery, vein and ureter enter and leave.
- Gerota's fascia
- The thin covering around the kidney and its surrounding fat.
- Warm ischemia time
- The minutes the kidney goes without blood flow while the artery is clamped.
- Off-clamp (zero ischemia)
- Removing the tumor without clamping the main artery.
- Selective clamping
- Clamping only the small branch artery that feeds the tumor's part of the kidney.
- Intraoperative ultrasound
- An ultrasound probe placed directly on the kidney during surgery to find the tumor's edges and depth.
- Renorrhaphy
- Stitching the kidney closed after the tumor is removed.
- Margin
- The rim of healthy tissue around the removed tumor. A negative margin means no tumor at the edge.
- Creatinine and eGFR
- Blood test numbers that show how well your kidneys filter. A lower eGFR means less kidney function.
- Pseudoaneurysm
- A weak, ballooned spot in a small artery after kidney surgery that can bleed later.
- Embolization
- Blocking a bleeding blood vessel from the inside using a thin catheter passed through an artery in the groin or wrist.
- Pathologist
- A doctor who examines tissue under a microscope and writes the report that says what the tumor was.
Common questions
Will I still have two kidneys?
Yes. Only the tumor and a thin rim of healthy tissue are removed, and the rest of the kidney stays and keeps working. The operated kidney loses a small amount of function, but most people notice no difference in daily life.
Does the robot do the surgery?
No. The robot holds the camera and instruments, but every movement is controlled by your surgeon at the console. It gives a magnified 3D view and wrist-like instruments that make fine stitching easier through small cuts.
How do you know it is cancer without a biopsy?
Solid kidney masses that light up with contrast dye on a CT or MRI are cancer in about 4 out of 5 cases. Many people go straight to surgery because the operation both treats and diagnoses the mass. A biopsy can help when the result would change the plan.
What if my surgeon has to take the whole kidney?
This happens in a small number of operations, when the tumor is deeper or larger than expected or bleeding cannot be controlled safely. Your surgeon will talk with you beforehand about your own chance. You can live a normal life with one healthy kidney.
Will I need chemotherapy?
Most people do not need any treatment after surgery for a small kidney cancer. Traditional chemotherapy does not work well for kidney cancer. For a small number of people with high-risk features, your team may discuss a year of immunotherapy.
Could the cancer come back?
For small, low-grade tumors that are fully removed, the chance of the cancer coming back is low. That is why follow-up scans continue for several years: to catch the uncommon return early, when it is easier to treat.
Do I need to change my diet or drink more water afterward?
Most people go back to a normal, healthy diet. Drink enough to keep your urine pale. Keeping your blood pressure and blood sugar well controlled protects the kidney function you have.
Sources this page draws on
- American Urological Association, Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline (2021)
- European Association of Urology, EAU Guidelines on Renal Cell Carcinoma
- American Cancer Society, Surgery for Kidney Cancer
- Urology Care Foundation, Kidney Cancer
- European Organisation for Research and Treatment of Cancer, EORTC 30904 randomized trial of nephron-sparing surgery versus radical nephrectomy (Van Poppel et al., European Urology) (2011)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.