V9-01 ROBOTIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL TUMORS

Abstract

You have accessJournal of UrologyRobotics – Renal1 Apr 2015V9-01 ROBOTIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL TUMORS Deepansh Dalela, Ravi Barod, and Craig Rogers Deepansh DalelaDeepansh Dalela More articles by this author , Ravi BarodRavi Barod More articles by this author , and Craig RogersCraig Rogers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2276AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy (RPN) in the setting of multiple renal tumors presents unique challenges. While previous reports have documented its feasibility, loner median operative times and length of stay have also been noted. In this video, we present key steps of performing robotic partial nephrectomy in multiple renal tumors. METHODS In this video, we show footage from different cases to highlight the four key areas in RPN for multiple renal tumors. First, we show the use of 4th arm for kidney retraction, allowing two-handed renal hilar dissection, followed by adequate kidney mobilization for providing optimal tumor exposure. Next, intraoperative ultrasound may be used for accurate anatomical identification of margins. Finally, we show techniques of on-demand ischemia, selective clamping, early unclamping, and cooling the kidney using ice to minimize ischemic damage to the kidney. RESULTS From 2008 to 2014, 30 patients underwent RPN for multiple renal tumors at our institution (Table 1). The mean size of the index tumor was 2.8 cm, and the RENAL nephrometry score was 8. Acceptable operating and warm ischemia times and estimated blood loss were achieved. There were two episodes of intraoperative bleeding. Focal positive surgical margins were seen in two patients who underwent tumor enucleation, one for hereditary papillary renal cell carcinoma (RCC) and the other for sporadic RCC. Both the patients were free of recurrence at two years follow-up CONCLUSIONS We present one of the largest single-center case series for multiple renal tumors exclusively undergoing RPN. Judicious use of the 4th arm, greater mobilization of the kidney for tumor exposure, use of the intraoperative ultrasound, and clamping modifications to reduce ischemic damage to the kidney may facilitate RPN in the setting of multiple tumors. Variables (n=30) Result Age; mean (SD) 60.8 (7.2) Index tumor diameter (cm); mean (SD) 2.8 (1) Nephrometry score (index tumor); median (IQR) 8 (7-9) OR time (min); median (IQR) 234 (211-272) Estimated blood loss (ml); median (IQR) 100 (93-212) Warm ischemia time (min); median (IQR) 22 (19-27) Intra-operative complications; n (%) 2 (6.7) Post-operative complications; n (%) 7 (24.1) Length of stay (days); median (IQR) 3 (2-3) Positive surgical margins (focal); n (%) 2 (6.7) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e775 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepansh Dalela More articles by this author Ravi Barod More articles by this author Craig Rogers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...