b'Redefining Research & Careproficient in the latest surgical approaches.Shining a Light So No TumorRobot-assisted surgeries and traditionalCells Are Left Behind open procedures are both performedWith support from the SPORE, Jeffrey in state-of-the-art operating rooms atCadeddu, M.D., Jinming Gao, Ph.D., and William P. Clements Jr. University Hospital.Gang Huang, Ph.D., have partnered to Operational since 2014, the hospital offersgenerate dyes that distinguish tumor cells the benefits of the latest technologies.from normal cells. The team has developed More than 300 patients undergonanoparticles that change depending on the nephrectomy (removal of a kidney) or partialenvironment, based on changes in the acid-nephrectomy each year. Most surgeriesity (pH) of tumors. When these nanoparticles are performed laparoscopically, meaningencounter tumors, they emit fluorescent Dr. Jeffrey Cadeddu leading a robotic surgery, one of the areas in which UT Southwestern isthrough small incisions about a half-inchlight that the surgeon can see with a special blazing a trail.long. Miniature video cameras aid thesedetector. This ensures that surgeons have procedures by letting surgeons peer insidethe opportunity to remove all the tumor cells. the cancer, heating and destroying tumorthe body. Laparoscopic techniques gener-cells. It is an outpatient procedure andally result in reduced pain and scarring, andControlling Small Tumorspatients recover quickly. (Olweny et al., Eurfaster recovery times. without SurgeryUrol, 2012; Ma et al., BJU Int, 2014)Some two-thirds of kidney cancerA clinical trial (NCT02141919) led by surgeries are aided by robots. These robotsradiation oncologist Dr. Raquibul Hannan Leaders in Robotic Surgery enable more agile and precise maneu- is evaluating the treatment of small renal verings. For example, robotic surgerymasses with radiation, as an alternative to Surgical volume improves patientfacilitates partial nephrectomies, highlyRFA or surgery. While conventional radia-outcomes. At UT Southwestern, kidneyintricate procedures that remove only thetion does not work well for kidney cancer, cancer patients benefit from a large,tumor rather than the whole kidney.improved outcomes are observed with experienced, pacesetting program. In 2007, Dr. Cadeddu became the firstmodern forms of radiation, such as SBRT U.S. surgeon to remove a kidney using(stereotactic body radiation therapy). ByKidney Cancer Program With the largest, most experienced kidneyLESS (laparoendoscopic single-site sur- projecting highly focused beams of radiationsurgeons perform more surgery program in North Texas, and onegery), which uses a single incision at theshot from many angles onto a tumor, lethalthan three times as manyDr. Vitaly Margulis, an of the top robotic kidney surgery programsnavel. This procedure leaves virtually nodoses can be administered. The procedure isexpert surgeon, in the surgeries as any otheroperating room.in the nation, UT Southwestern has a ver- scar. (Krabbe et al., Semin Intervent Radiol,noninvasive and can treat tumors otherwise satile team of fellowship-trained urologists2014; Raman et al., Eur Urol, 2009)difficult to access.hospital in the region.Tackling Large TumorsMasters of Complex Surgeries vena cava), the main conduit of blood fromthe heart and lungs during the surgery. Intricate kidney cancer operations arethe body back into the heart. TravelingThese challenging operations are routine commonly performed at Simmonswithin the vena cava, a tumor can extendfor Kidney Cancer Program specialists, who Comprehensive Cancer Center. Kidneyinto the heart. Along the way, it can blockhave found a 30 percent reduction in compli-Cancer Program surgeons perform moreliver blood drainage, a life-threateningcations between 2006 and 2012 with expert than three times as many surgeries as anycomplication. Further, pieces of the tumorteams and advanced surgical techniques.other hospital in the area. Experience gainedmay break off, travel through the heart,Efforts are also directed to identify factors from the volume and complexity of proce- lodging themselves in small lung arteries,that can predict for complications. Leading a dures makes a difference in the operatingcausing deadly pulmonary embolisms andnational team including MD Anderson Cancer room. These complex surgeries are done atlung infarcts.Center and Mayo Clinic, UT Southwestern William P. Clements Jr. University Hospital,Complex procedures to treat kidneyurologists recently determined that tumors recognized as the best hospital in Dallas bytumors invading major veins involve expertthat develop blood clots were associated U.S. News & World Report and recipient ofurologists such as Drs. Margulis and Arthurwith worse outcomes. (Haddad et al., Urolthe national Rising Star Award from VizientSagalowsky, who team up for this surgeryOncol, 2015; Gayed et al., BMC Urol, 2016; for improved quality and safety.with cardiothoracic surgeons, such asHutchinson et al., Urology, 2018) Nearly two-thirds of all kidney cancer surgeriesAmong the most complex proceduresDr. Michael Wait. When necessary, patientsUT Southwestern Urology ranks No. 3 in are aided by robots. is the removal of kidney tumors invadingare temporarily placed on a heart-lungthe U.S., based on academic contributions. through the renal vein into the IVC (inferiormachine, which takes over the functions of(Kutikov et al., Eur Urol, 2012)30 31'