AUA 2006 - ABST [1688] LAPAROSCOPIC AND ROBOTIC REPAIR OF RENAL ARTERY ANEURYSMS

Anil Kapoor*, Hamilton, ONCanada; Patrick P Luke, London, ON, Canada.

Introduction and Objective: Repair of renal artery aneurysms (RAA) is difficult via the traditional open surgical route. Current literature regarding laparoscopic management of renal artery aneurysms is sparse. We reviewed our preliminary experience with laparoscopic management of renal artery aneurysms (3 cases) including one case performed with the da Vinci ® robotic system. We describe our experience with these three cases including technique, results, complications, and short-term follow-up.

Methods: 3 patients underwent laparoscopic resection of partly calcified renal artery aneurysm from 01/03 to 08/04 using five-port (2- 10 mm, 3- 5 mm) technique. The indications to operate were increasing diameter, incomplete calcification and size greater than 2.5 cm. Patients were given the option of open or laparoscopic repair, with the low-threshold to convert to open repair in the advent of surgical difficulty. The size of the aneurysms were 2.5-2.8 cm. Age ranged from 52 y.o.-73 y.o. The da Vinci ® robotic system was used in the third case (PL) to perform the entire dissection, resection and anastomosis.

Results: All patients underwent successful repair of RAA. The total operative time was 200 -360 minutes, with warm ischemia time of 24-59 minutes. The estimated blood loss ranged between 300cc- 650 cc. No intraoperative complications occurred and intraoperative doppler ultrasound demonstrated good flow to the entire kidney. Average hospital stay was 3 days. Post-operatively the patients underwent repeat MR angiography showing no evidence of aneurysm or stenosis. Renal scan confirms global perfusion. All three patients are currently two years post-surgery with normal blood pressure and renal function.

Conclusions: This is the largest series, to our knowledge, of laparoscopic repair of partly calcific renal artery aneurysms. Quick and accurate laparoscopic suturing skills are essential to avoid prolonged warm ischemia. To our knowledge, this is also the first reported robot-assisted laparoscopic renal artery aneurysm repair. The enhanced dexterity and precision of the robot permits resection of the entire abnormal vascular segment (including the back wall), making laparoscopic resection a viable alternative to open repair. Further experience will ideally minimize warm ischemic time.
Wednesday, Wednesday, May 24, 2006 3:30 PM
Moderated Poster: Renal Transplantation: Renal Vascular Surgery (II) (3:30 PM-5:30 PM)

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