Category: Robotic Surgery: New Techniques - Malignant

Introduction & Objective :

According to international guidelines, partial nephrectomy should be performed in small renal masses whenever technically feasible. Even for renal tumors larger than 7 cm, partial nephrectomy seems to provide similar oncologic outcomes if compared with radical nephrectomy. There is a trend that complex renal tumors are treated by nephron-sparing surgery. Intraoperative imaging may help perform oncologically safe partial nephrectomy as it can be used for tumor localization and also differentiate tumor from normal kidney parenchyma and assess a surgical cavity and margins of a resected specimen. Up-to-date intraoperative imaging techniques, which can aid in complete RCC resection, are as follows: intraoperative ultrasonography, fluorescence imaging, augmented reality, optical coherence tomography, ex vivo MRI.

Methods :

We present 4 cases of robot-assisted and laparoscopic partial nephrectomy with use of intraoperative fluorescence imaging.

Results :

Advantages of fluorescence imaging during partial nephrectomy include: aid in intraoperative differentiation between tumor and normal tissue (RCCs appear hypofluorescent compared with normal kidney parenchyma); potentially assisting in tumor margin demarcation; facilitating selective arterial clipping by in-vivo visualization of the arterial branches; defining a devascularized area during selective clipping and also defining normal vascularization (absence of ischemic zones) after suturing the tumor bed.

Conclusions :

Fluorescence imaging is simple and safe method that bring a lot of additional information during partial nephrectomy.

Presenting Author(s)

• EB

  Evgeny Bezrukov

  – Head of the urological department №1, Sechenov University, Moscow, Moskva, Russia

Author(s)

• LR

  Leonid Rapoport

  – Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
• ES

  Evgeny Sirota

  – Moscow, Moskva, Russia
• RS

  Roman Slusarenco

  – Moscow, Moskva, Russia

Presenting Author(s)

• AM

  Andrei Morozov

  – Urologist, Sechenov First Moscow State Medical University, Moscow, Moskva, Russia

Author(s)

• NS

  Nikita Sushentsev

  – Moscow, Moskva, Russia