V04-11 Robotic Salvage Partial Nephrectomy After Failed Cryotherapy

You have accessJournal of UrologyAdrenal/Renal Oncology I (V04)1 May 2024V04-11 ROBOTIC SALVAGE PARTIAL NEPHRECTOMY AFTER FAILED CRYOTHERAPY Carol L. Feng, Antonio Franco, Celeste Manfredi, Francesco Ditonno, Savio Domenico Pandolfo, Riccardo Lombardo, Antonio Cicione, Cosimo De Nunzio, Alexander K. Chow, and Riccardo Autorino Carol L. FengCarol L. Feng , Antonio FrancoAntonio Franco , Celeste ManfrediCeleste Manfredi , Francesco DitonnoFrancesco Ditonno , Savio Domenico PandolfoSavio Domenico Pandolfo , Riccardo LombardoRiccardo Lombardo , Antonio CicioneAntonio Cicione , Cosimo De NunzioCosimo De Nunzio , Alexander K. ChowAlexander K. Chow , and Riccardo AutorinoRiccardo Autorino View All Author Informationhttps://doi.org/10.1097/01.JU.0001009444.59519.d3.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic partial nephrectomy in the salvage setting represents a challenging procedure and remains underreported in contemporary literature. The aim of this video is to demonstrate its feasibility and safety for a kidney cancer after failed primary cryotherapy. METHODS: A 59 year-old man with past medical history of right renal cell carcinoma (RCC) initially treated with cryoablation in 2020 presented with local recurrence. CT imaging demonstrated 2.6 cm (cT1a) right renal mass underwent a robotic partial nephrectomy. To note, pathology report from previous biopsy percutaneous cryoablation showed grade 1 RCC. Preoperative creatinine was 1.3 mg/dL. Steps of the procedure are illustrated in the present video. RESULTS: After robot docking, the surgeon identified the inferior vena cava and the renal vein. Dissection of the hilum was then performed to expose the renal artery. The kidney was then freed within the Gerota's fascia, which was notably difficult due to intense inflammation and adhesions of the previous cryoablative treatment. Intraoperative ultrasound was used to confirm and assess mass's margins and labels. Enucleoresection was performed with cold scissors. Early unclamping was performed with a warm ischemia time of 25 min. Renorrhaphy was then performed in a single layer fashion, due to the proximity of the renal mass to the hilar structures. The tumor was bagged. Operative time was 180 minutes. Estimated blood loss was 550 mL. No perioperative complications occurred. Patient was discharged on postoperative day 1. Pathology showed a pT1a grade 3 clear cell RCC with negative margins. CONCLUSIONS: Salvage robotic partial nephrectomy should be considered as treatment option after initial failure of primary ablative therapy. While the procedure is more challenging than its standard counterpart, it can be safely carried out with good surgical outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e199 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carol L. Feng More articles by this author Antonio Franco More articles by this author Celeste Manfredi More articles by this author Francesco Ditonno More articles by this author Savio Domenico Pandolfo More articles by this author Riccardo Lombardo More articles by this author Antonio Cicione More articles by this author Cosimo De Nunzio More articles by this author Alexander K. Chow More articles by this author Riccardo Autorino More articles by this author Expand All Advertisement PDF downloadLoading ...