This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.
Subtitle: Not All Renal Tumors Can Be Resected Equal
Riccardo G. Bertolo – Urology Unit – “San Carlo di Nancy Hospital”, Rome, Italy
Introduction: Enucleation during robotic partial nephrectomy (RPN) can ease and/or minimize the renorrhaphy. But enucleation is not always feasible. In the accompanying video, two emblematic clinical cases of RPN are showed to open up a point of reflection about the impact of anatomo-pathological tumor characteristics on the accomplishment of an anatomical resection strategy.
Methods: First case presented refers to a 69 years-old gentleman diagnosed with a 5-cm – R.E.N.A.L. 9 – suspicious mediorenal right-sided mass. Second case presented refers to a 27 years-old guy diagnosed with a 5-cm – R.E.N.A.L. 7 – right-sided mass located at the lower pole. After accurate counseling, the patients underwent transperitoneal RPN.
Results: In both cases off-clamp approach was chosen. In the first case, a pure enucleation resection technique was pursued (Surface-Intermediate-Base score = 0). No renorrhaphy was performed at the end of the procedure given the absence of bleeding. Pathology analysis revealed a clear cell renal cell carcinoma, pT1b, G3, with negative margins. The maximum width of the rim of healthy tissue excised was 0.2 mm, with evident tumor pseudocapsule 0.7-0.8-mm thick. In the second case, a mini-enucleo-resection technique was pursued (Surface-Intermediate-Base score = 1-2). Selective single-layer renorrhaphy was performed at the end. Final pathology revealed low-grade oncocytic tumor, pT1b, R0. The maximum width of the rim of healthy tissue excised was 1.5-mm, with no evidence of tumor pseudocapsule.
Conclusions: Notwithstanding the surgeon’s intent to pursue an anatomical resection strategy, anatomo-pathological tumor’s characteristics could impact on the resection technique actually performed. We need tools to preoperatively predict such characteristics.