Inderbir Gill, M.D., founding executive director, USC Institute of Urology, and chairman and professor, Catherine and Joseph Aresty Department of Urology at the Keck School of Medicine of USC, is the first surgeon in the world to use FDA cleared advanced robotic technology to remove a kidney tumor in an outpatient procedure.

Inderbir Gill, M.D., founding executive director, USC Institute of Urology, and chairman and professor, Catherine and Joseph Aresty Department of Urology at the Keck School of Medicine of USC, is the first surgeon in the world to use FDA cleared advanced robotic technology to remove a kidney tumor in an outpatient procedure.

Keck Medical Center of the University of Southern California (USC) is the first medical center in the world to use new robotic technology in an outpatient procedure for a kidney cancer patient.

Urologic surgeons at the USC Institute of Urology, part of Keck Medicine of USC, used a Food and Drug Administration (FDA)-cleared laparoscopic device, the high intensity focused ultrasound (HIFU) surgical ablation system for ablating intra-abdominal tumors. The system enables surgeons to penetrate the abdominal cavity with keyhole cuts to eliminate tumors of four centimeters or less.

Inderbir Gill, M.D., founding executive director, USC Institute of Urology, and chairman and professor, Catherine and Joseph Aresty Department of Urology at the Keck School of Medicine of USC, performed the surgery on patient Gary Fradkin, a 62-year-old Van Nuys resident, who went home the same day, three to four days less than patients typically experience with kidney cancer surgery.

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“Using a focused beam of ultrasound directly on the tumor and minimally invasive surgery, we destroyed the tumor without surgically removing it from the body,” Gill said. “The most important aspects of this technology are the reduced trauma to the patient and the ability to save the kidney, without the tumor, for a healthier lifestyle post-surgery. This surgery offers fewer chances for infection and post-operative complications. Our goal is to save as much of the good kidney as possible and help patients return to a normal lifestyle quickly.”

According to the American Cancer Society, nearly 64,000 new cases of kidney cancer will occur in 2014, of which nearly 14,000 Americans will die from the disease. Kidney cancer is one of the 10 most common cancers in men and women and has been on the increase since the 1990s with a typical patient at an average age of 65. Some research indicates the possible increase may be because of improved imaging tests. Yet, while diagnoses are increasing, survival rates are also increasing, especially among expert surgeons using advanced technology.

HIFU surgery is an option for patients whose tumors are four centimeters or smaller, which accounts for about 10 percent of all kidney tumors, Gill said. Although this surgery was on a kidney, HIFU surgery can also be an option for cancer of the prostate, liver, pancreas and other organs.

For Fradkin, a post-production engineer who builds screening rooms and performs other software and hardware installation work as part of the film industry, the faster recovery time of the HIFU procedure is advantageous to his busy work life and active, healthy lifestyle. Fradkin previously had two cancerous kidney tumors removed by Gill at Keck Medical Center of USC, whom he credits with saving his kidney after another urologist recommended removing it. Fradkin’s kidneys continue to have functioning problems, leaving limited options for removing one kidney, said Gill, who is recognized internationally for his work in robotic surgery and expertise in complicated procedures. Gill pioneered and perfected the procedure to maintain uninterrupted blood flow to the kidney during surgery, making the kidney more viable after the tumor is removed.

For Fradkin, the prospect of being inactive bothered him more than cancer surgery. An avid cross-fit athlete and windsurfer, getting back to his day-to-day life as quickly as possible was the key to saying yes to the new procedure.

“The cancer part didn’t scare me,” Fradkin said. “But at 62 years old it’s hard to keep in shape, and I was worried about starting all over again, especially with my cross-fit class. The silver lining this time is that this is an outpatient procedure. It didn’t surprise me a bit that Dr. Gill would suggest this new technology. He’s always on the cutting edge of surgery.”

Most kidney tumors are discovered when they are small and the patient is not experiencing symptoms, which was the case with Fradkin. Although traditional surgery is an effective remedy, the risk of complications from such surgery can be daunting.

Of 12 patients in the United Kingdom who participated in a 2011 proof-of-concept study of HIFU for kidney tumors, seven were cancer-free after 24 months.

by Leslie Ridgeway