Robot Assisted Partial Nephrectomy in a Horseshoe Kidney

This video was entered by Dr. Alessandro Volpe in the 2022 KS International Robotic Surgery Innovation Awards, sponsored by the Vattikuti Foundation. It was featured in the Vattikuti Symposium ‘Humans at the Cutting Edge of Robotic Surgery,’ held in Miami, Florida November 19, 2022.

Here is the Abstract:

We present the case of a 34 years old man with an incidental 33 mm renal mass in the histmus of an horseshoe kidney. The right kidney had 3 arteries. A RAPN with selective clamping was performed with the daVinci Xi using the Firefly fluorescence tool.

The patient was placed in a supine position with the right flank lifted at 20°. Four 8 mm robotic ports and two 12 mm ports for the assistant were placed. The daVinci Xi System was used in a 4- arms configuration. The isthmus of the horse-shoe kidney and the renal tumor were exposed. The three right renal arteries were progressively prepared. The assessment of the CT angiogram suggested the mass was fed by the lower right artery. After clamping off this artery with a robotic bulldog, IndoCianine Green (ICG) 10 mg was injected and the Firefly fluorescence surgical tool was employed to confirm a complete devascularization of the renal mass. The borders of the renal tumor were carefully assessed using a drop-in ultrasound probe and the line of incision was scored on the parenchyma. The resection of the mass was then carried out with cold scissors under selective ischemia. Medullary e cortical suture with sliding clip techinique. At the end Surgiflo was applied on the renal breach.

Operative time and console time were 165 minutes and 125 minutes, respectively. WIT 9 minutes. The intraoperative blood loss was 100 ml. No complications reported. Pathology showed clear cell renal carcinoma, pT1a with negative surgical margins.

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