Category: Laparoscopic/ Robotic: Renal
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
Sunil Patel– Resident, 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
Urologic Oncology Fellow
University of California San Diego
San Diego, California
Medical School: East Carolina University
Residency: Maine Medical
Fellowship: Uro/Onc UCSD