V9-11 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC RENAL MASSES: VARIATIONS IN SURGICAL TECHNIQUE

Abstract

You have accessJournal of UrologyRobotics - Renal1 Apr 2016V9-11 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC RENAL MASSES: VARIATIONS IN SURGICAL TECHNIQUE Daniel Ramirez, Matthew J. Maurice, Peter A. Caputo, Ryan J. Nelson, Ercan Malkoc, Onder Kara, and Jihad H. Kaouk Daniel RamirezDaniel Ramirez More articles by this author , Matthew J. MauriceMatthew J. Maurice More articles by this author , Peter A. CaputoPeter A. Caputo More articles by this author , Ryan J. NelsonRyan J. Nelson More articles by this author , Ercan MalkocErcan Malkoc More articles by this author , Onder KaraOnder Kara More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1202AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy (RPN) for completely endophytic renal masses is feasible with increased robotic surgical experience. In this video we demonstrate our surgical technique for robotic partial nephrectomy, focusing on the technical variations for RPN for completely endophytic tumors. METHODS Between June 2006 and August 2015, our institution performed 1,123 partial nephrectomies. 130 were performed for completely endophytic renal tumors. We present 2 patients with completely endophytic, central renal masses who underwent RPN, one in the left kidney and one in the right. Our approach to surgical removal of completely endophytic renal tumors includes the use of intraoperative ultrasound to delineate the margins of the mass, initial shallow angle of resection to improve visualization of the parenchymal margin and tumor base, and correction of excision trajectory at the renal sinus. This technique is described in detail in our video presentation. RESULTS Of the 1,123 RPN performed at our institution over the last 10 years, 11.6% were performed for completely endophytic renal masses. Mean operative time, warm ischemia and estimated blood loss in this cohort were 180 minutes, 24.5 minutes, and 197 cc, respectively. Minor complicate rate in this group was 13.9%, while major complication rate was 13.9%. 7 patients in this group had positive margins (5.4%). Successfully surgical extirpation of completely endophytic renal masses is optimized by an initially shallow incision in order to obtain a clear view of the parenchymal edge and base of tumor. Once the sinus fat and collecting system are exposed, the trajectory of the excision is corrected and the sides and back of the tumor are excised in a step-wise, circumferential fashion. CONCLUSIONS RPN for completely endophytic renal tumors is feasible and necessitates technical variations in excision in order to optimize outcomes. Excision of the tumor should be performed in a step-wise systematic fashion with a shallow initial incision to improve visualization into the renal defect and to avoid cutting into the tumor. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e863 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel Ramirez More articles by this author Matthew J. Maurice More articles by this author Peter A. Caputo More articles by this author Ryan J. Nelson More articles by this author Ercan Malkoc More articles by this author Onder Kara More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...