Comprehensive uro-oncology surgery — with a primary focus on radical and nephron-sparing partial nephrectomy for kidney cancer, cystectomy for bladder cancer, penile cancer surgery with VEIL groin dissection, and robotic approaches across all procedures.
Urological cancers encompass malignancies of the kidney, bladder, prostate, penis, testis, and ureter. Surgical oncology is central to curative treatment in all these conditions — from nephron-sparing partial nephrectomy for small kidney tumours to radical cystectomy with urinary diversion for muscle-invasive bladder cancer, and VEIL (Video Endoscopic Inguinal Lymphadenectomy) for penile cancer nodal staging.
Dr. Gore's uro-oncology training at Tata Memorial Hospital, Mumbai — covering nephrectomy, cystectomy, prostatectomy, and penile cancer surgery — combined with his FARIS Edinburgh robotic surgery credentials, enables him to offer the complete range of open and robotic uro-oncological procedures at Sahyadri Manipal Hospitals, Pune.
The primary surgical focus in this practice is kidney cancer — both radical nephrectomy and nephron-sparing partial nephrectomy — where the decision between complete and partial kidney removal has major implications for long-term renal function and quality of life. This decision is individualised based on tumour size, location, complexity, and the patient's baseline kidney function.
In kidney cancer surgery, one principle guides my decision-making above all others: nephron-sparing surgery whenever oncologically safe. Losing a kidney means losing half your filtration capacity — which has real long-term consequences for cardiovascular health and quality of life, particularly in patients who are older or have diabetes.
For penile cancer, the VEIL procedure — robotic video-endoscopic inguinal lymphadenectomy — has been transformative. Previously, groin node dissection was a major operation with high wound complication rates. Robotically, we can achieve the same oncological result through small port incisions, with dramatically fewer wound problems and faster recovery.
— Dr. Vinod T. Gore, MBBS MS FAIS FIAGES FARIS (Edin)Renal cell carcinoma — radical nephrectomy, partial nephrectomy (nephron-sparing), robotic kidney surgery
Primary FocusSquamous cell carcinoma — penectomy, VEIL robotic groin node dissection, sentinel node, inguinal LND
Full CoverageNMIBC & MIBC — TURBT, radical cystectomy with ileal conduit or neobladder, intravesical BCG
Full CoveragePSA-detected, robotic radical prostatectomy, active surveillance — brief overview, see robotic site
Brief OverviewRenal cell carcinoma (RCC) is the most common kidney cancer in adults — and surgery is the only curative treatment. The key surgical decision is whether to perform nephron-sparing partial nephrectomy or complete radical nephrectomy.
Complete details on robotic kidney surgery — radical nephrectomy, partial nephrectomy, RENAL scoring, warm ischaemia time, outcomes and recovery by Dr. Vinod T. Gore.
bestroboticsurgeonpune.in/Robotic NephrectomyRenal cell carcinoma arises from the renal tubular epithelium and accounts for ~90% of all kidney cancers. Most RCCs are incidentally detected on ultrasound or CT done for other reasons — presenting as asymptomatic renal masses. The classic triad of haematuria, loin pain, and a palpable mass occurs in only 10% of cases and usually indicates advanced disease.
Unlike most cancers, RCC does not respond well to chemotherapy or radiotherapy — surgery is the mainstay of curative treatment. For localised disease, surgical cure rates are excellent — 5-year survival exceeds 90% for Stage I tumours. Even in advanced disease, surgical debulking (cytoreductive nephrectomy) combined with targeted therapy improves survival in selected patients.
The most important surgical decision is whether to perform partial nephrectomy (removing only the tumour with a margin of normal kidney tissue) or radical nephrectomy (removing the entire kidney). Partial nephrectomy preserves kidney function and is the preferred approach whenever technically feasible — particularly for tumours ≤7cm (T1–T2a).
Most common — 70–80%. Responds to VEGF-targeted therapy (Sunitinib, Pazopanib) and immunotherapy (Nivolumab + Ipilimumab) in advanced disease.
Type 1 and Type 2 — 10–15%. Better prognosis than clear cell in most cases. MET mutations in hereditary papillary RCC.
5–7% — arises from collecting duct cells. Excellent prognosis when localised. Low risk of metastasis compared to clear cell.
Rare, aggressive variants — collecting duct carcinoma, medullary carcinoma, translocation RCC. Often require different systemic therapy.
The choice between nephron-sparing partial nephrectomy and complete radical nephrectomy is the most important decision in kidney cancer surgery. The guiding principle is: partial nephrectomy whenever oncologically safe — preserving kidney function has significant long-term health benefits.
Removes only the tumour with a margin of normal kidney tissue (5–10mm) — leaving the majority of the kidney intact and functioning. The gold standard for T1 tumours (<7cm) and mandatory when radical nephrectomy would leave the patient with inadequate renal function (solitary kidney, bilateral tumours, CKD).
Removes the entire kidney along with surrounding Gerota's fascia, adrenal gland (if involved), and regional lymph nodes. Indicated for large, central, or hilar tumours where partial nephrectomy cannot achieve clear margins safely, or for T3–T4 disease with venous extension or local invasion.
The TNM stage, RENAL nephrometry score, and baseline renal function together determine the optimal surgical approach for each patient — reviewed at multidisciplinary tumour board before proceeding.
| Stage | Description | Preferred Surgery | Approach | Adjuvant |
|---|---|---|---|---|
| T1a (≤4cm) | Small tumour confined to kidney — most common incidentally found RCC | Partial Nephrectomy | Robotic or laparoscopic — day care to 2 days | None — surveillance |
| T1b (4–7cm) | Moderate tumour, still confined to kidney — partial feasible in most | Partial Preferred | Robotic partial or radical depending on RENAL score | None — surveillance |
| T2a (7–10cm) | Larger tumour — partial if technically feasible, radical if not | Radical Nephrectomy | Laparoscopic or open — depending on size | Adjuvant Pembrolizumab (intermediate-high risk) — 1 year |
| T2b (>10cm) | Large tumour confined to kidney — radical nephrectomy standard | Radical Nephrectomy | Open — vascular control, large specimen | Adjuvant Pembrolizumab (high risk) — 1 year |
| T3a–b (Vein / Fat) | Perinephric fat invasion, renal vein or IVC thrombus — requires vascular surgery expertise | Radical + Thrombectomy | Open — IVC thrombus may need cardiac bypass (Level III–IV) | Adjuvant Pembrolizumab |
| T4 / M1 | Beyond Gerota's fascia or metastatic disease | Cytoreductive ± Systemic | Cytoreductive nephrectomy in selected M1 cases before TKI/immunotherapy | VEGF-TKI + Immunotherapy (Nivolumab + Cabozantinib, Pembrolizumab + Axitinib) |
Bladder cancer is the most common urological cancer after prostate cancer. The fundamental distinction between non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) disease determines the entire surgical strategy.
Bladder cancer — predominantly transitional cell (urothelial) carcinoma — originates from the inner lining of the bladder. The most important initial assessment is whether the tumour has invaded the bladder muscle (detrusor) — this single fact determines whether conservative or radical surgical treatment is required.
For NMIBC (Ta, T1, Tis — no muscle invasion), treatment is transurethral resection (TURBT) followed by intravesical BCG or chemotherapy instillation — preserving the bladder. For MIBC (T2–T4), radical cystectomy — complete removal of the bladder — is the curative treatment, combined with neoadjuvant platinum-based chemotherapy which improves survival by approximately 8%.
Urinary diversion after cystectomy is constructed from intestine — the two main options being an ileal conduit (urostomy bag) or an orthotopic neobladder (a new bladder reservoir sutured to the urethra, allowing normal voiding). The choice depends on patient preference, tumour location, and urethral margins.
Stage Ta, T1, CIS — tumour confined to the inner lining. TURBT (Transurethral Resection of Bladder Tumour) — endoscopic, no incision. Followed by intravesical BCG for high-grade or CIS to prevent recurrence and progression. Cystoscopy surveillance every 3–6 months.
Bladder-Preserving — TURBT + BCGStage T2–T4 — tumour invades the detrusor muscle. Neoadjuvant cisplatin-based chemotherapy (MVAC or GC × 3–4 cycles) followed by Radical Cystectomy — complete removal of the bladder, prostate (men), or uterus/anterior vaginal wall (women), pelvic lymphadenectomy, and urinary diversion. Gold standard curative treatment.
Radical Cystectomy + Urinary DiversionExtended Pelvic Lymphadenectomy: Bilateral pelvic node dissection — obturator, external iliac, internal iliac, common iliac, presacral nodes — for staging and survival benefit
Radical Cystoprostatectomy (men): En-bloc removal of bladder, prostate, seminal vesicles, distal ureters. Nerve-sparing technique preserves erectile function in selected patients
Anterior Exenteration (women): Bladder, urethra, uterus, ovaries, anterior vaginal wall — modified in selected cases to preserve sexual function
Urinary Diversion — Ileal Conduit: 15–20cm of ileum used to create a stoma — simple, reliable, no continence required. Most common diversion globally
Orthotopic Neobladder: Detubularised ileal reservoir sutured to urethra — patient voids per urethra. Requires strict patient selection and post-op training. Better QoL but longer surgery and learning curve
Recovery: 7–10 days hospital. Return to full activity in 6–8 weeks. Adjuvant Nivolumab (immunotherapy) for pT3/N+ disease post-cystectomy — 1 year
Penile cancer — predominantly squamous cell carcinoma — requires careful management of both the primary tumour and the inguinal lymph nodes. Lymph node management determines survival in penile cancer. The VEIL procedure (Video Endoscopic Inguinal Lymphadenectomy) has revolutionised groin node surgery.
Video Endoscopic Inguinal Lymphadenectomy (VEIL) — complete information on robotic groin dissection, technique, outcomes, and wound complication reduction by Dr. Vinod T. Gore.
bestroboticsurgeonpune.in/Robotic Groin Node DissectionPenile cancer most commonly presents as a lesion on the glans or prepuce — a non-healing ulcer, exophytic growth, or indurated plaque in a patient often with a history of phimosis or poor hygiene. Human Papillomavirus (HPV) — particularly HPV 16 and 18 — is implicated in approximately 50% of cases.
The primary tumour is managed surgically — with the extent of resection determined by tumour size, location, and depth of invasion. The guiding principle is to achieve clear surgical margins while preserving as much penile length and function as possible. For small, superficial lesions this may mean wide local excision or glansectomy — reserving partial or total penectomy for larger or more invasive tumours.
The most critical prognostic factor is inguinal lymph node status — approximately 50% of patients with clinically enlarged nodes have metastatic disease. Inguinal lymphadenectomy is both staging and therapeutic. The VEIL procedure performs this through three small port incisions in the thigh, under video endoscopic guidance — achieving equivalent nodal yield to open dissection with dramatically fewer wound complications (open groin dissection has 30–50% major wound complication rates).
For superficial tumours (T1a, small T1b) — excision of the lesion with a clear surgical margin. Glansectomy (removal of the glans alone) with reconstruction using split-skin graft. Preserves penile shaft length and urethral function. Preferred over amputation whenever oncologically safe.
Organ-PreservingPartial penectomy — for tumours where glans-preserving surgery cannot achieve clear margins, or for larger invasive tumours. A minimum 2cm margin of uninvolved shaft is preserved. Total penectomy with perineal urethrostomy — reserved for large proximal tumours or recurrence after partial penectomy.
Stage-Based SelectionFor cN0 patients with T1b+ tumours — dynamic sentinel node biopsy using Technetium-99m ± ICG identifies the first-echelon inguinal node. If positive, full inguinal dissection (VEIL or open) is performed. Avoids unnecessary prophylactic groin dissection in node-negative patients.
Staging — cN0 PatientsVideo Endoscopic Inguinal Lymphadenectomy — performed through 3 small ports in the thigh under video endoscopic guidance. Equivalent nodal yield to open inguinal dissection. Dramatically fewer wound complications (wound necrosis, infection, lymphocele, lymphoedema) — the major morbidity of open groin dissection. Performed robotically for maximum precision and minimal tissue trauma.
Robotic VEIL — PreferredProstate cancer is the most common cancer in men globally. Surgical treatment — radical prostatectomy — is one of the most frequently performed robotic operations. Full information is available at Dr. Gore's dedicated robotic surgery website.
Complete guide to robotic prostatectomy — nerve-sparing technique, continence, PSA follow-up, risk groups, and patient eligibility by Dr. Vinod T. Gore, FARIS Edinburgh.
bestroboticsurgeonpune.in/Robotic Radical ProstatectomyProstate cancer is diagnosed by elevated PSA, confirmed on TRUS or MRI-guided biopsy, and managed based on risk stratification (D'Amico classification) — low, intermediate, or high risk based on PSA level, Gleason score, and clinical stage. Not all prostate cancers require immediate surgery.
For localised prostate cancer, the main treatment options are robotic radical prostatectomy, external beam radiotherapy + brachytherapy, or active surveillance (for low-risk disease). Robotic prostatectomy offers surgical cure with the potential for nerve-sparing (preserving urinary continence and erectile function) and precise lymph node dissection for staging.
Robotic radical prostatectomy — performed using the da Vinci system — provides superior 3D visualisation of the neurovascular bundles, bladder neck, and urethral anastomosis in the confined male pelvis, with significantly lower blood loss and faster recovery than open retropubic prostatectomy. Full details, patient criteria, and outcomes are available at Dr. Gore's robotic surgery website.
Active surveillance — PSA + MRI monitoring. Surgery or radiotherapy when progression detected. Immediate treatment often not needed.
Robotic radical prostatectomy with pelvic lymph node dissection, OR external beam radiotherapy + short-term androgen deprivation therapy.
Robotic radical prostatectomy with extended pelvic LND, OR radiotherapy + long-term ADT ± abiraterone. Multidisciplinary decision essential.
All robotic urology procedures performed by Dr. Gore are covered in detail on his dedicated robotic surgery website. Click any card to visit the specific procedure page.
Complete overview of all robotic urological cancer surgery procedures
bestroboticsurgeonpune.in →Radical & partial nephrectomy — kidney cancer surgery, RENAL scoring, warm ischaemia
bestroboticsurgeonpune.in →Video Endoscopic Inguinal Lymphadenectomy for penile cancer — groin node dissection
bestroboticsurgeonpune.in →Nerve-sparing radical prostatectomy — continence, PSA, pelvic LND, patient selection
bestroboticsurgeonpune.in →All robotic urology procedures, patient eligibility, outcomes data, and appointment booking — FARIS Edinburgh trained, Best Robotic Oncosurgeon NBT 2024.
bestroboticsurgeonpune.in/Robotic uro-oncology surgeryFor kidney tumour assessment, bladder cancer evaluation, penile cancer surgery, or any urological cancer concern — book a consultation with Dr. Gore for a complete surgical workup and individualised treatment plan.