V377 TECHNIQUE OF ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL LESIONS

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V377 TECHNIQUE OF ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL LESIONS David Josephson, Chris Whelan, John Yamzon, Clayton Lau, Bertram Yuh, and Timothy Wilson David JosephsonDavid Josephson Duarte, CA More articles by this author , Chris WhelanChris Whelan Duarte, CA More articles by this author , John YamzonJohn Yamzon Duarte, CA More articles by this author , Clayton LauClayton Lau Duarte, CA More articles by this author , Bertram YuhBertram Yuh Duarte, CA More articles by this author , and Timothy WilsonTimothy Wilson Duarte, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We highlight the technical aspects of robotic assisted laparoscopic partial nephrectomy for multiple left renal masses on a patient with Von Hippel-Lindau syndrome (VHL). METHODS The patient is a 24 old female with bilateral renal masses, with 4 lesions on the right and 9 on the left, the largest being 3 cm. We approached this as a staged bilateral partial nephrectomy utilizing robotic assistance. Management of her left kidney proceeded as described. She is secured to the table in a left modified flank position. Following establishment of a pneumoperitoneum, a 12 mm midline camera port is placed followed by two lateral 8mm robotic ports. After the robot is docked, the operation commences with standard robotic techniques for renal dissection and exposure of the hilum. Next, the perirenal fat is mobilized with sharp dissection and monopolar cautery, exposing the renal capsule in its entirety. Laparoscopic ultrasound is used to confirm the location and depth of the tumors. The hilum is clamped and all lesions were sharply excised. Retrograde ureteral injection of methylene blue identifies a collecting system defect, which is closed with vicryl suture. Running renorrhaphy sutures through the capsule are used to close the renal defects. Hemostatic agents are placed followed by removal of the hilar bulldog clamps. Excised tumors are removed through a laparoscopic retrieval bag. RESULTS Procedure time was 240 minutes. Warm ischemia time was 34 minutes. Blood loss was 350 ml. The patient was discharged home on postoperative day 4 and recovered well. Creatinine was unchanged from baseline at 1.08. Final pathology shows 9 separate tumors, all clear cell carcinoma, grade 2. All permanent margins were negative. CONCLUSIONS Robotic assisted laparoscopic partial nephrectomy is safe and effective for management of multiple renal tumors in a single operative setting. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e153 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Josephson Duarte, CA More articles by this author Chris Whelan Duarte, CA More articles by this author John Yamzon Duarte, CA More articles by this author Clayton Lau Duarte, CA More articles by this author Bertram Yuh Duarte, CA More articles by this author Timothy Wilson Duarte, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...