Dept of Uro-Oncology, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi.
Partial nephrectomy has become the standard of care as a nephron-sparing procedure in properly selected patients with a Stage T1 tumor. With the advent of minimally invasive surgery, robotic partial nephrectomy has become a better alternative to open surgery for small renal masses with the advantage of faster recovery. Though routinely performed, robotic partial nephrectomy is technically demanding and may prove challenging in certain situations like multiple renal vessels. We hereby present our experience of a robotic partial nephrectomy case for a small renal mass in a kidney with multiple renal arteries.
44 years old gentleman presented with an incidentally detected right renal mass. His clinical examination was unremarkable and all routine laboratory parameters were within normal limits. On preoperative DTPA scan, glomerular filtration rate(GFR) of right kidney was 42.1 ml/min, with a global GFR of 79.4. Contrast CT of abdomen showed a well-defined heterogeneously enhancing mass of size 49x37x44mm arising from upper pole of right kidney. Metastatic workup was negative. We did robotic partial nephrectomy using da Vinci Xi system. Intraoperatively, we found multiple renal arterial vessels, which could be managed with loop tourniquet and bulldog clamps.
Total console was time 3 hours 30minutes and warm ischemia 29min 10 sec. Estimated blood loss was 200 ml. Post-operative recovery was uneventful with a total 2 days of hospital stay. Histo-pathological examination showed Clear cell RCC, Fuhrman’s grade 2, with all resection margins negative.
RAPN represents a safe and effective nephron-sparing surgery technique even for a kidney with multiple renal vessels. Innovation in the form of using vessel loop to take control of multiple vessels can be utilised. Whenever possible, CT renal angiogram must be included in preop imaging workup.
This was a Finalist in the Robotic Surgeons Council of India KS Robotic Surgery Awards for May, 2018.
Video presentation, Narrated, with CT Scans, photos, PPT’s and robotic surgery videos, 07:02