Department of Urology, All India Institute of Medical Sciences, New Delhi, India
Introduction: Morbid obesity, hilar tumor location and underlying kidney disease make partial nephrectomy a challenging procedure. We demonstrate our robot-assisted technique in one such case.
Patient and method: A 53 yr old woman with hypertension, diabetes and chronic kidneys disease was incidentally detected to have a 3.5cm mass in the interpolar region of the left kidney. The lesion arose from the posterior lip of renal cortex, abutting the hilum and invading renal sinus fat. The RENAL nephrometry score was 9p. Her blood pressure was controlled on 5 drugs, diabetes required 46 units of insulin and creatinine was 4.1mg%. Her weight was 100kg and BMI was 40.
Results: She was planned for robot-assisted partial nephrectomy and was optimized for surgery with 1 session of pre-operative hemodialysis and 2 units packed red cell transfusion. Robotic partial nephrectomy was performed in the right lateral position using a 4 arm, da-Vinci S device. After isolation of the renal vessels, the kidney was bared of its fat, the tumor was identified and separated from the hilum and posterior segmental vessels. Both artery and vein were then clamped and the tumor was excised using cold scissors. Sliding renorraphy was performed in a standard fashion. The total clamp time was 31min and blood loss was 200ml. She had uneventful recovery and was discharged on a creatinine of 4.4mg%.
Conclusion: In patients with imperative indications, a partial nephrectomy may be attempted even if the tumor characteristics make it challenging. Using the robotic platform may enhance the possibility of a minimally invasive approach.
Narrated robotic surgery video, with MRI’s, Photos, Diagrams and robotic surgery clips, 07:35.