Bilateral Laparoscopic Partial Nephrectomies: A Case Report

Sravan Panuganti,Louis Raphael Kavoussi,Simpa Samuel Salami

doi:10.1089/cren.2015.0007

Abstract

Although laparoscopy is a recognized operative approach to the management of renal masses, there is currently no standardized approach to manage bilateral synchronous renal masses. We present a case of synchronous bilateral renal masses, identified during work-up for flank pain, and managed simultaneously with laparoscopic partial nephrectomies. The patient is a 42-year-old Caucasian male found to have bilateral renal masses during evaluation for left flank pain. Cross-sectional imaging studies showed a 7.0 × 7.3 × 5.2 cm anterior, mid-to-lower pole mass on the left kidney and a 1.5 × 1.9 × 1.6 cm medial lower pole mass on the right kidney. He underwent bilateral laparoscopic partial nephrectomy at the same setting, with an uncomplicated postoperative course. Pathology report revealed clear cell renal-cell carcinoma (ccRCC) on both sides. He had normal renal function and no evidence of recurrence in the first 6 months of follow-up. This case demonstrates the possibility and safety of performing bilateral laparoscopic partial nephrectomies in one operative session. Our review of the literature supports the role of genetic counseling and the need for long-term surveillance in young patients having RCC.

Highlights

Introduction and BackgroundMajority of renal masses are identified incidentally
We present a case of synchronous bilateral renal masses, identified during work-up for flank pain, and managed simultaneously with laparoscopic partial nephrectomies
With only few cases reported in the literature, there is currently no consensus regarding the operative approach to the management of bilateral synchronous renal masses

Summary

Introduction and Background

Majority of renal masses are identified incidentally. Multiple tumors identified less than 6 months apart are classified as synchronous, whereas tumors identified more than 6 months apart are classified as metachronous. It is agreed that a minimally invasive technique results in improved short-term outcomes, namely shorter hospital stay, decreased narcotic pain medication requirements, and short convalescence, there is no consensus on how to approach synchronous bilateral renal masses. After an uneventful ureteroscopy and laser lithotripsy of the left 7 mm ureteral calculus at an outside hospital (OSH), he was referred to our institution 1 month later for evaluation of his renal masses At 6-month followup, his serum creatinine was 0.97 mg/dL and he had no evidence of recurrence

Discussion and Literature

Conclusion

Findings

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