Category: Laparoscopic/ Robotic: Renal
Introduction & Objective :
There is evidence that longer ischemia time is associated with short and long-term renal consequences. Nevertheless, minimally ischemic and off-clamp Partial Nephrectomy (PN) are considered technically demanding procedures with potential for increased blood loss. Therefore, avoiding global renal ischemia should be particullarly applicable for patients with decreased baseline renal function. To help decision making about off-clamp laparoscopic PN based on a standardized preoperative imaging report.
Information about tumor location, relationship with collecting system, presence of feeding arteries and pseudocapsule integrity using a standardized method were recorded. The video shows two patients underwent off-clamp laparoscopic tumor enucleation after a meticulous analysis of preoperative imagining. In the first case we present a 57 years old woman diagnosed with right renal tumor and normal renal function. Renal tumor information were resumed as follows: 3.4 cm right renal mass PADUA score 6, loacated on segment 9, 70% exophytic, 15 mm distant from collecting system, absence of feeding arteries and integrity of the pseudocapsule surrounding the tumor. In the second case we present a 50 years old gentleman with stage 3 cronic kidney disease diagnosed with right oncocytoma. Tumor morphological characteristics were summarized as follows: 4 cm right renal tumor involving segments 3 and 1, 30% exophytic, 3 mm distant from the collecting system, no feeding arteries identified and a complete pseudocapsule surrounding the tumor.
In the first case operative time was 115 minutes, estimated boold loss was 250 ml and the patient was discharged 3 days after surgery. Final pathology showed pT1a cromophobe RCC. In the second case operative time was 125 minutes, estimated boold loss was 300 ml and the patient was discharged 3 days after surgery. Final pathology confirmed the diagnosis of oncocytoma.
Preoperative imaging with standardized method to report renal mass and meticulous analysis of tumor characteristics can help urologists to offer patients a tailored surgical approach finalized to maximize renal function preservation without undermining oncologic principles and safety.
Riccardo Mastroianni– resident , Campus Bio-Medico University of Rome, Rome, Lazio, Italy
Rocco Papalia– Rome, Lazio, Italy
Alessandro Giacobbe– Turin, Piemonte, Italy
Elia Luperto– Rome, Lazio, Italy
Marisa Kurti– Turin, Piemonte, Italy
Federico Germinale– Turin, Piemonte, Italy
Gianluca Muto– Florence, Toscana, Italy
Gerardo Paolo Flammia– Rome, Lazio, Italy
Giovanni Muto– Turin, Piemonte, Italy
Campus Bio-Medico University of Rome
Rome, Lazio, Italy
Mastroianni Riccardo (10/02/1989) is at third year of residency in Urology at Campus Bio-Medico University of Rome.