Category: Laparoscopic/ Robotic: Renal

VS7-12 - Simultaneous resection of multiple renal tumors by Robot assisted laparoscopic Partial Nephrectomy

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

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

I am a clinical research assistant professor at Yonsei University College of Medicine, Severance Hospital. My main focus is on kidney cancer, kidney donor, minimally invasive surgerys including robotic and VAMS.

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

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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

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

Young Deuk Choi

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seoul, Seoul-t'ukpyolsi, Republic of Korea

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