V11-07 TECHNIQUES OF ROBOTIC ASSISTED PARTIAL NEPHRECTOMY WITH RENAL VEIN TUMOR THROMBECTOMY AND RECONSTRUCTION: UCSD EXPERIENCE

Abstract

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-07 TECHNIQUES OF ROBOTIC ASSISTED PARTIAL NEPHRECTOMY WITH RENAL VEIN TUMOR THROMBECTOMY AND RECONSTRUCTION: UCSD EXPERIENCE Devin Patel, Daniel Holdst, Garrick Greear, Fady Ghali, Juan Javier-DesLoges, Sunil Patel, and Ithaar Derweesh Devin PatelDevin Patel More articles by this author , Daniel HoldstDaniel Holdst More articles by this author , Garrick GreearGarrick Greear More articles by this author , Fady GhaliFady Ghali More articles by this author , Juan Javier-DesLogesJuan Javier-DesLoges More articles by this author , Sunil PatelSunil Patel More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of partial nephrectomy for renal cell carcinoma with clinical extracortical invasion represents the frontier of the utilization of nephron sparing technique. Herein we describe our results and techniques in selected cases of robotic partial nephrectomy with renal vein tumor thrombectomy. METHODS: Robotic ports are placed in a linear configuration angled towards the kidney in a cranial to caudal direction. The case is started with bowel mobilization. In cases of left sided tumors, complete spleen, pancreatic tail and adrenal mobilization. For right sided tumors, kocherization of the 3rd segment of the duodenum to fully expose the inferior vena cava followed by adrenal mobilization. In all instances, the renal artery and main renal vein are clamped. In cases of medially located tumors and with thrombi terminating in a segmental branch, the renal vein is dissected medially to identify segmental branches. The segmental branch with tumor thrombus is isolated and clipped or stapled. In cases of more posteriorly located tumors or with tumor within the main renal vein, the tumor is resected towards the tumor thrombus. The thrombus is then identified at the point of inception and dissected proximally until complete resection. The renorrhaphy is completed in a two-layer fashion, with early hilar unclamping. RESULTS: Total operative time in three cases ranged from 264-322 minutes with an estimated blood loss in the range of 200 cc to 500 cc. The warm ischemia time ranged from 28 minutes to 37 minutes. Two patients were discharged home on post-operative day two and the third patient discharged on post-operative day three. No patients sustained an immediate post-operative complication or 30-day readmission for complication. All three patients maintained renal function >90% of baseline. Final pathology on all three specimens confirmed pT3a disease with negative margins in all cases. CONCLUSIONS: Robotic partial nephrectomy is feasible and safe for select clinical T3a renal masses, with acceptable quality outcomes. Further investigation is required to help clarify the role of minimally invasive partial nephrectomy in these advanced stage localized tumors. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e859-e860 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Devin Patel More articles by this author Daniel Holdst More articles by this author Garrick Greear More articles by this author Fady Ghali More articles by this author Juan Javier-DesLoges More articles by this author Sunil Patel More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Loading ...