#278 Purely Off-clamp RAPN for cT2b renal mass- Dr. Leonardo Misuraca

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.

From the entry:

Abstract: Purely Off-clamp RAPN for cT2b renal mass

Introduction & Objectives Sutureless approach has gaining popularity for its feasibility, safety, promising functional outcomes, shorter operative time and length of stay. In this video we describe our surgical technique applied to a complex case of cT2b renal mass.

Materials & Methods Patient was placed in extended flank position. A transperitoneal six-port access was used with a four-arm configuration. Crucial surgical steps included straight access to the tumour, avoiding hilum isolation, tumour identification and margins scoring, enucleation/enucleoresection, selective control of all arterial feeders, hemostasis of resection bed with “sutureless technique”. Any unintended violation of renal calyces were repaired contextually.

The illustrated case involved a 55 years old man with a 15 cm left kidney mass without haematuria, who asked for conservative option considering his familiar history for kidney cancer.

Results Operative time was 260 min, EBL 700 mL and LOS 5 days. Final histology showed Chromophobe Renal Cell Carcinoma, pT2b. No intra or perioperative blood transfusion was needed. Creatinine remained stable at 1-month evaluation. Postoperative course was uneventful. In a recent PSM analysis conducted at our center, we compared sutureless approach with renorraphy approach both in the setting of purely off-clamp RAPN. Sutureless patients had shorter hospital stay, negligible complications and increased likelihood of achieving Trifecta. At Kaplan- Maier analysis, significant CKD stage migration free survival probabilities were comparable between groups.

Conclusions Purely off-clamp sutureless RAPN is safe and feasible in cT2b patients, with negligible complications and minimal impact on perioperative renal function. Larger case series and longer follow-up are needed to demonstrate the potential long-term benefits.

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