V04-05 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR HIGHLY COMPLEX ENDOPHYTIC TUMOR: A NOVEL RENORRHAPHY CLOSURE

Abstract

You have accessJournal of UrologyAdrenal & Renal Oncology I (Nephron Sparing Surgery) (V04)1 Sep 2021V04-05 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR HIGHLY COMPLEX ENDOPHYTIC TUMOR: A NOVEL RENORRHAPHY CLOSURE Jennifer Espinales and Firas Petros Jennifer EspinalesJennifer Espinales More articles by this author and Firas PetrosFiras Petros More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002000.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiple suture techniques have been proposed for renal closure for endophytic tumors during robot-assisted partial nephrectomy (RAPN). There is no consensus for preferred closure technique and this decision is at the discretion of the surgeon. This video demonstrates a novel approach of closure in a completely endophytic, highly complex tumor without the need for bolster. METHODS: A da Vinci Xi Robot was used for RAPN. After using intraoperative ultrasound to aid in tumor identification and define borders of resection, tumor was dissected free from normal parenchyma. Following the resection, a central defect was present over the renal pelvis. Inner renorrhaphy of resection borders was performed with 3-0 V-loc suture. Once the hilar vessels were unclamped, no significant active bleeding was noted from the resection bed. The capsular layer was performed using Weck-renorrhaphy sutures of 2-0 Vicryl suture to close the remaining portion of exposed renal parenchyma in a C-shaped horizontal mattress using sliding-clip renorrhaphy without using bolsters. Tisseel and Fibrillar hemostatic agents were applied to the resection bed and hilum. RESULTS: Surgical outcome revealed warm ischemia time (WIT) was 23 times, estimated blood loss (EBL) was 40 mL, and console time was 160 minutes. Parenchymal preservation was approximately 90%. Pathology showed pT1a clear-cell renal cell carcinoma with negative margins. There were no intraoperative or postoperative complications, and the patient was discharged on post-operative day 1. An 18-month follow-up showed no evidence of recurrence with normal renal function. CONCLUSIONS: RAPN is technically feasible for highly complex endophytic and hilar tumors that would otherwise be managed with radical nephrectomy. For select cases such as our case, we presented a novel renorrhaphy closure with C-shaped horizontal mattress as a valuable-asset for robotic surgeons to achieve an excellent clinical, oncological and functional outcome. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e292-e292 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Espinales More articles by this author Firas Petros More articles by this author Expand All Advertisement PDF downloadLoading ...