Category: Laparoscopic/ Robotic: Renal

VS8-8 - Solitary kidney robotic partial nephrectomy with 2 lesions: utilization of clampless and segmental ischemic technique to achieve optimal outcome

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

Introduction & Objective :

Partial nephrectomy began in the realm of solitary kidneys. The MIS approach to solitary kidneys is gaining traction, but multiple lesions is associated with prolonged ischemia time and associated sequela. We believe patients can benefit from the shortened convalescence of MIS approach in a solitary kidney with well selected multiple lesions with shortened ischemia and great outcomes, measured by trifecta (negative margins, 90% or above pre-operative renal function, and no intraoperative complications). We present the feasibility of a trifecta outcome using two tiered approach to ischeia 

Methods : Patient is a 55 yo male with solitary right kidney. Prior left renal cell carcinoma led to a radical nephrectomy. He presented with 2 spontaneous renal masses on his solitary kidney. One peri-hilar lesion (2.2cm) with associated segmental artery, and the other is a 1.7cm lower pole exophytic lesion. Renal function was egfr>60 (Cr = 1.19) pre-operatively. We performed a robotic assisted partial nephrectomy of both lesions. The peri-hilar lesion we incorporated a segmental arterial approach, and the lower pole lesion we used a clampless approach. 

Results : Both lesions were removed with negative margins. He had an uneventful course and renal function was unchanged at discharge Cr = 1.21 (eGFR>60). 

Conclusions : In select patients with solitary kidneys, partial nephrectomy of multiple lesions is possible, and utilization of multiple ischemia modalities can be performed to maintain renai function and achieve trifecta.

Stephen Ryan

Urologic Oncology Fellow
University of California San Diego
San Diego, California

Medical School: East Carolina University
Residency: Maine Medical
Fellowship: Uro/Onc UCSD

Sunil Patel

University of California San Diego
San Diego, California

Madhumitha Reddy

University of California San Diego
San Diego, California

Unwanaobong Nseyo

La Jolla, California

Daniel Han

University of California San Diego
San Diego, California

Ithaar Derweesh

Professor of Urology and Radiology Program Director, Urologic Oncology Fellowship
Department of Urology, University of California San Diego School of Medicine
San Diego, California