Category: Laparoscopic/ Robotic: Renal
VS7-12 - Simultaneous resection of multiple renal tumors by Robot assisted laparoscopic Partial Nephrectomy
Introduction & Objective : Many treatment methods can be considered for a patient presenting with multiple renal tumors. However, when the patient has a low baseline renal function or there is concurrent disease on the contralateral kidney, every effort must be made to minimize nephron loss during treatment. While nephron sparing surgery is currently the standard treatment of small renal tumors with superior oncologic and functional outcome, it is challenging to perform on multiple tumors. We here present a case of robot assisted laparoscopic partial nephrectomy(RALPN) of multiple tumors.
Methods :
RALPN was performed in the conventional method. The patient is placed in a semilateral position. One camera port, two 8mm ports for robotic arms, and a 12mm assistant port at the low abdomen was placed. (Fig 1, right). The Da Vinci Si platform was used.
Results :
A 59-year-old male patient presented with multiple bilateral renal tumors. Clear cell renal cell carcinoma had been confirmed on biopsy at another hospital. Preoperative serum creatinine was 1.56 mg/dL with an estimated GFR of 46 ml/min/1.73 m².
Staged operation was planned and resection of three tumors on the left kidney was performed. There was a 4cm exophyting mass at lateral aspect, a 2.5cm exophyting mass at the upper pole, and a 1.6cm endophytic mass at the mid posterior aspect. (Fig 1, left)
Total operation time was 282 min, console time 205 min, and warm ischemic time was 49 min. The resected tumors were also confirmed as clear cell renal cell carcinoma with Fuhrman grade 3. Resection margins were free from carcinoma. The patient was discharged 5 days after surgery without complication. On the day of discharge, serum creatinine was 1.54 mg/dL with an estimated GFR of 46 ml/min/1.73 m² which was equivalent to the preoperative level.
Conclusions : Resection of multiple renal tumors can be done safely by a Robotic approach, and kidney function can be preserved by enucleating the tumors to minimized loss of normal renal parenchyma.
Joon Chae Na
– Clinical Research Assistant Proffessor, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea, Seoul, Seoul-t'ukpyolsi, Republic of Korea- HL
Hyung Ho Lee
– Goyang-si, Kyonggi-do, Republic of Korea 
Young Eun Yoon
– clinical assistant professor, Hanyang University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea- WH
Won Sik Ham
– Associated professor, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea, Seodaemun-gu, Seoul-t'ukpyolsi, Republic of Korea - KR
Koon Ho Rha
– Professor, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea, Seodaemun-gu, Seoul-t'ukpyolsi, Republic of Korea - YC
Young Deuk Choi
– Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea, Seoul, Seoul-t'ukpyolsi, Republic of Korea - SH
Sung Joon Hong
– Professor, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea, Seoul, Seoul-t'ukpyolsi, Republic of Korea 
Woong Kyu Han
– Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea, Seoul, Seoul-t'ukpyolsi, Republic of Korea