V04-12 ROBOT-ASSISTED PARTIAL NEPHRECTOMY USING INTRA-ARTERIAL RENAL HYPOTHERMIA FOR HIGHLY COMPLEX ENDOPHYTIC OR HILAR TUMORS

Abstract

You have accessJournal of UrologyAdrenal & Renal Oncology I (Nephron Sparing Surgery) (V04)1 Sep 2021V04-12 ROBOT-ASSISTED PARTIAL NEPHRECTOMY USING INTRA-ARTERIAL RENAL HYPOTHERMIA FOR HIGHLY COMPLEX ENDOPHYTIC OR HILAR TUMORS Pieter De Backer, Joris Vangeneugden, Charles Van Praet, Maryse Lejoly, Saar Vermijs, Caroline Vanpeteghem, and Karel Decaestecker Pieter De BackerPieter De Backer More articles by this author , Joris VangeneugdenJoris Vangeneugden More articles by this author , Charles Van PraetCharles Van Praet More articles by this author , Maryse LejolyMaryse Lejoly More articles by this author , Saar VermijsSaar Vermijs More articles by this author , Caroline VanpeteghemCaroline Vanpeteghem More articles by this author , and Karel DecaesteckerKarel Decaestecker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002000.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is the gold standard treatment for patients with T1 renal masses. In highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage in prolonged clamping. Different open and laparoscopic techniques include cold saline surface irrigation, peri-renal ice slush, retrograde ureteral cooling and intra-arterial cooling. We describe the first case series and surgical video of intra-arterial cold perfusion through arteriotomy in robot-assisted PN (RAPN). METHODS: Four patients with a complex renal tumor (PADUA score 10-12) were treated with RAPN with intra-arterial cold ischemia in the period March - October 2020. Preoperative imaging confirmed two endophytic lesions and two hilar lesions with no distant disease. Considering the anatomical complexity, three-dimensional (3D) models were used for preoperative planning and perioperative guidance. During RAPN, the renal artery and vein were clamped and following arteriotomy and venotomy, 4°C cold saline was perfused in the renal artery. After tumor excision and renorrhaphy, artery and vein were sutured and clamps were removed. RESULTS: No intraoperative complications occurred. Median surgical time (skin to skin) was 235 min (interquartile range [IQR] 226-307). Median warm and cold ischemia time was 4 min (IQR 3,25-4) and 56,5 min (IQR 40,75-76,75) respectively. Median rewarming ischemia time was 8 min (IQR 8-10,25). Median pre- and postoperative (1 month) glomerular filtration rates were 89 (IQR 83,5-90) and 80 mL/min (IQR 71-90) respectively . The median estimated blood loss was 140 mL (IQR 108-488). Length of stay was 3 days for all patients. Pathological examination showed negative surgical margins, 2 oncocytomas, 1 clear cell renal cell carcinoma and 1 reninoma. One patient experienced hematuria 2 weeks after surgery and underwent selective segmental embolization for a pseudo-aneurysm (Clavien-Dindo grade 3b). No other postoperative complications occurred. CONCLUSIONS: We demonstrate the feasibility and to our knowledge the first surgical video of a RAPN procedure using intra-arterial renal hypothermia through arteriotomy. This approach allows for minimal invasive nephron sparing surgery in complex renal masses where longer clamping time is to be expected. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e295-e295 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pieter De Backer More articles by this author Joris Vangeneugden More articles by this author Charles Van Praet More articles by this author Maryse Lejoly More articles by this author Saar Vermijs More articles by this author Caroline Vanpeteghem More articles by this author Karel Decaestecker More articles by this author Expand All Advertisement PDF downloadLoading ...