Category: Laparoscopic/ Robotic: Renal

VS8-10 - Robotic Partial Nephrectomy for an endophytic cT2 renal mass, R.E.N.A.L. score 12

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Robotic surgery has widened the indications of the conservative treatment for renal masses. The aim of the video is to report our step-by-step technique for robotic partial nephrectomy in a highly complex renal mass


Methods :

A 78 years old male came to our attention for a complex right renal mass. Past medical history included severe hypertension and a myocardial infarction with subsequent stent placement in 2014. Baseline renal function assessed by serum creatinine was 1.2 mg/dl. The preoperative computed tomography scan and magnetic resonance showed a right enhancing posterior renal mass, 7.6 cm in diameter, cT2a, RENAL score 12. The patient was scheduled for robotic partial nephrectomy. Transperitoneal approach with 3 arms robotic configuration was chosen.


Results :

Operative time including robot’s docking was 195 min. Warm ischemia time was 19 min. Blood losses were negligible, with no transfusions required. Length of stay was 10 days due to a pneumonia treated by antibiotics. Serum creatinine at discharge was 1.15 mg/dl. Final pathology revealed a clear cell renal cell carcinoma, pT3b, ISUP grade 3, involving the sinus fat and the renal vein. Surgical margins were negative.  


Conclusions :

Robotic nephron-sparing approach was successful even in case of a completely endophytic renal mass. Consistent experience is needed before embarking in this surgery. Reports on long term oncological outcomes for such lesions are awaited.

Jose Luis Bauza Quetglas

Resident
Hospital Universitari Son Espases
Manacor, Islas Baleares, Spain

Jose Luis Bauza Quetglas MD. Urology chief resident at Hospital Universitari Son Espases, Palma de Mallorca - Spain.

Riccardo Bertolo

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Turin, Piemonte, Italy

Riccardo Bertolo, MD
Research Fellow, Robotic Urology,
Cleveland Clinic, Cleveland, OH, USA
PhD Candidate, Bioengineering in Medical/Surgical Sciences
Turin Politechnic, Italy

Juan Garisto

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Juan Garisto, MD is an Advanced Laparoscopy & Robotics clinical fellow at Cleveland Clinic, Cleveland, OH, United States under the mentorship of Dr. Jihad Kaouk. He completed a Society of Urologic Oncology fellowship at the University of Toronto and did his urology residency training at Complejo Hospitalario Dr. A.A.Madrid in Panama City, Panama.

His current research interest in single port surgery and multidisciplinary management of urologic malignancies, in particular kidney and bladder cancer.

Daniel Sagalovich

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Enrique Pieras

Palma de Mallorca, Islas Baleares, Spain

Pedro Piza

Palma de Mallorca, Islas Baleares, Spain

Jihad Kaouk

Professor and Director, Center for Robotic and Image Guided Surgery Vice Chair, Surgical Innovations
Glickman Urologic Institute, Cleveland Clinic
Cleveland, Ohio

Jihad Kaouk, MD FACS

Dr. Jihad Kaouk is an American Board certified Urologist and Director, Center of Robotic and Image Guided Surgery at the Cleveland Clinic Glickman Urological Institute. He also serves as Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, Vice Chair for Surgical Innovations and chair holder for the Zegarac-Pollock Endowed Chair in laparoscopic and robotic surgery.
In Innovations, he has performed several first ever done surgical procedures, including the first Robotic single port surgery through the belly button in 2008, the first completely transvaginal kidney removal in 2009, and the first robotic perineal prostatectomy in 2014 Dr. Kaouk holds 2 USA patents for medical devices used during partial nephrectomy and in robotic surgery.

Since 2005, Dr. Kaouk has served on committees at the national and local levels. From 2005-2008, he served in the American Urological Association’s Urologic Diagnostic and Therapeutic Imaging Task Force, from 2006-2010 he was on the Guidelines for the Management of small Renal Masses committee. Currently Dr Kaouk serves as Chairman elect on the AUA New Technology and Imaging committee, and is President Elect of (SURS) Society of Urologic Robotic Surgery. Dr Kaouk is associate editor of Urology journal.

Dr Kaouk have lectured in 130 scientific meetings, chaired 24 urologic meeting and performed live surgery in 18 medical centers worldwide. He authored 460 peer reviewed scientific publication, 26 book chapters and hundreds of scientific abstracts and surgical movies. Dr Kaouk received 32 honors and awards including Cleveland clinic innovator award twice, Teacher of the Year award, and EndoUrology 2017 Best Fellowship Program Director Award.

Presently, Dr Kaouk holds membership with the American Urological Association, the Endourological Society, Society of Urologic Oncology, Society of Robotic Surgery, and the Lebanese Order of Physicians. He is a fellow of the American college of Surgeons.