Category: Robotic Surgery: UpperTract - Malignant

VS7-9 - Robot assisted partial nephrectomy: our experience of tackling multiple renal hilar vessels.

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

Introduction & Objective :

Partial nephrectomy has become the standard of care as a nephron-sparing procedure in properly selected patients of small renal masses. With the advent of minimally invasive surgery, robotic partial nephrectomy has become a better alternative to open surgery with the advantage of faster recovery. Though routinely performed, robotic partial nephrectomy is technically demanding and may prove challenging in certain situations like multiple renal vessels. We hereby present our experience of a robotic partial nephrectomy case for a small renal mass in a kidney with multiple renal arteries, which could not be identified on preoperative imaging.


Methods :

A 44 years old gentleman presented with an incidentally detected right renal mass. His clinical examination was unremarkable and all routine laboratory parameters were within normal limits. On preoperative renal scan, glomerular filtration rate(GFR) of the right kidney was 37.3 ml/min, with a global GFR of 79.4. Contrast CT of abdomen showed a well-defined heterogeneously enhancing mass measuring 49x37x44mm arising from upper pole of right kidney. Multiple hilar vessels could not be appreciated on CT. Metastatic workup was negative. We did robotic partial nephrectomy using da Vinci Xi system. Intraoperatively, we found multiple renal hilar vessels, which could be managed with loop tourniquet and bulldog clamps<./p>


Results :

The total console was time 3 hours 30minutes and warm ischemia 29min 10 sec. Estimated blood loss was 200 ml. Post-operative recovery was uneventful with a total 2 days of hospital stay. Histo-pathological examination showed Clear cell RCC, Fuhrman’s grade 2, with all resection margins negative. 


Conclusions :

RAPN represents a safe and effective nephron-sparing surgery technique even for a kidney with multiple renal vessels. Innovation in the form of using vessel loop to take control of multiple vessels can be utilised. Whenever possible, CT renal angiogram must be included in preop imaging workup to avoid intraoperative surprises.

Saurabh RAMESH. Patil

Fellow, Robotic Uro-oncology
Max Institute of Cancer care, New Delhi, India
Bhoiwada, Mumbai, Maharashtra, India

Ashwin Tamhankar

Fellow, Robotic Uro-oncology
Max Institute of Cancer care, New Delhi, India
Mumbai, Maharashtra, India

Surya Ojha

Supervisor, Robotic Surgery program
Max Institute of Healthcare, New Delhi, India
New Delhi, Delhi, India

Puneet Ahluwalia

Consultant, Uro-oncology And Robotic Surgery
Max Institute of Cancer care, New Delhi, India
Gurgaon, Delhi, Delhi, India

Gagan Gautam

Head, Urologic oncology And Robotic Surgery
Max Institute of Cancer care, New Delhi, India
Gurgaon, Delhi, Delhi, India