V7-03 ROBOTIC PARTIAL NEPHRECTOMY WITH SELECTIVE CLAMPING FOR RENAL MASS IN

Abstract

You have accessJournal of UrologyPediatrics1 Apr 2017V7-03 ROBOTIC PARTIAL NEPHRECTOMY WITH SELECTIVE CLAMPING FOR RENAL MASS IN <15KG PEDIATRIC PATIENT: TECHNIQUES ADAPTED FROM ADULT UROLOGY Patricia S. Cho, Michael V. Hollis, Briony K. Varda, Erin R. McNamara, Richard N. Yu, Andrew A. Wagner, and Richard S. Lee Patricia S. ChoPatricia S. Cho More articles by this author , Michael V. HollisMichael V. Hollis More articles by this author , Briony K. VardaBriony K. Varda More articles by this author , Erin R. McNamaraErin R. McNamara More articles by this author , Richard N. YuRichard N. Yu More articles by this author , Andrew A. WagnerAndrew A. Wagner More articles by this author , and Richard S. LeeRichard S. Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1921AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy (RPN) provides for nephron sparing and renal preservation with a minimally invasive approach. Though commonly utilized in adults for resection of renal masses, it is less commonly applied for tumors in children. To optimize outcomes in these patients, techniques from the adult setting were translated to the pediatric realm, with the goals of fostering bi-directional transfer of expertise and knowledge and of achieving safe and effective application of this surgical approach. METHODS A collaborative team was formed and consisted of a pediatric urologist trained in minimally invasive and oncologic surgery as primary surgeon with an adult minimally invasive oncologic urologist as proctor. Key aspects for translation to the pediatric setting included: port placement, lower insufflation pressure, choice and size of instruments and supplies, and minimization of potential hemorrhage and ischemia with selective clamping/early unclamping technique. This approach was applied to a 14 kilogram, 3 year old female with a right lower pole lesion with cystic and solid components, concerning for malignancy. RESULTS The mass was resected with negative margins and demonstrated benign pathology. Clamp time was 14 minutes, and EBL was minimal. There were no intra- or post-operative complications. The patient's creatinine was unchanged, and a follow-up ultrasound demonstrated no residual mass in a normal appearing right kidney. CONCLUSIONS Collaboration of experienced pediatric and robotic teams allows for successful adaptation of adult techniques to pediatric patients. Specific considerations must be made in order to achieve safety and feasibility of RPN with selective clamping for renal preservation in cases of pediatric renal masses. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e823-e824 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Patricia S. Cho More articles by this author Michael V. Hollis More articles by this author Briony K. Varda More articles by this author Erin R. McNamara More articles by this author Richard N. Yu More articles by this author Andrew A. Wagner More articles by this author Richard S. Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...