Robotic Partial Nephrectomy For Complex Hilar Tumors: Tips & Tricks

To report our step-by-step technique and provide tips & tricks for robotic partial nephrectomy (RPN) in a highly complex renal mass. Robotic surgery has widened the indications of the conservative treatment for renal masses1. With increasing experience, larger deeply infiltrative tumors, or tumors involving the renal hilum can be treated with robotic partial nephrectomy2,3.

A 78 years old male came to our attention for a complex right renal mass. Past medical history included severe hypertension and a myocardial infarction with subsequent stent placement in 2014. Baseline renal function assessed by serum creatinine was 0.93 mg/dl. The preoperative computed tomography scan and magnetic resonance showed a right enhancing posterior renal mass, 7.6 cm in diameter, cT2a, RENAL score 12. The patient was scheduled for robotic partial nephrectomy. Transperitoneal approach with 3 arms robotic configuration was chosen.

Operative time including robot's docking was 195 min. Warm ischemia time was 19 min. Blood losses were negligible, with no transfusions required. Serum creatinine at discharge was 1.15 mg/dl. Final pathology revealed a clear cell renal cell carcinoma, pT3b, ISUP grade 3, involving the sinus fat and the renal vein. Surgical margins were negative.

Robotic partial nephrectomy can be successfully performed in cases of completely endophytic central, hilar masses. Consistent experience is needed before embarking on this surgery. Future studies are needed to determine the long term outcomes for partial nephrectomy for these complex tumors.

Urology. 2018 Aug 02 [Epub ahead of print]

Jose Luis Bauza, Daniel Sagalovich, Riccardo Bertolo, Juan Garisto, Enrique Pieras, Pedro Piza, Jihad Kaouk

Urology department, Hospital Universitario Son Espases, Palma de Mallorca, Illes Balears - Spain. Electronic address: ., Center for Laparoscopic and Robotic Surgery, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio - United States., Urology department, Hospital Universitario Son Espases, Palma de Mallorca, Illes Balears - Spain.