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You have accessJournal of UrologyAdrenal/Renal Oncology II (V14)1 May 2024V14-08 ROBOTIC-ASSISTED LAPAROSCOPIC ANATROPHIC PARTIAL NEPHRECTOMY FOR MANAGEMENT OF A COMPLETELY ENDOPHYTIC RENAL MASS Dylan Buller and Ryan Dorin Dylan BullerDylan Buller and Ryan DorinRyan Dorin View All Author Informationhttps://doi.org/10.1097/01.JU.0001008704.74547.03.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Completely endophytic renal masses represent a technical challenge when considering surgical intervention. When possible, partial nephrectomy (PN) is preferred to radical nephrectomy, but may still result in excessive loss of healthy renal parenchyma for endophytic central tumors. Here, we present a case of a patient with a centrally located completely endophytic renal tumor managed with robotic-assisted laparoscopic anatrophic PN. METHODS: A 45 year-old male with a previously biopsied renal mass was referred for urologic consultation; biopsy demonstrated grade 2 clear-cell renal cell carcinoma (RCC). MRI revealed a right 3.5cm centrally located completely endophytic interpolar renal mass. The patient elected to proceed with robotic-assisted PN. An anatrophic incision was planned. Anatrophic nephrolithotomy was historically utilized in open surgery for the removal of large renal calculi. The kidney is opened along "Brodel's bloodless line." This is the site of a relatively avascular plane through the kidney as it lies between the anterior and posterior renal vasculature. The term "anatrophic" refers to a renal incision that will not result in atrophy of the kidney. RESULTS: The kidney was mobilized completely; two renal arteries and one renal vein were identified. The posterior artery was clamped and indocyanine green administered. Using Firefly imaging guidance, the portion of the kidney supplied by the posterior renal artery remained dull, while the portion supplied by the anterior vasculature fluoresced. The interface between these two zones was thereby marked as the site of Brodel's avascular line. Both renal arteries and the renal vein were clamped. The kidney was opened along Brodel's line. The endophytic renal mass was identified and carefully resected from the surrounding renal parenchyma, and the kidney subsequently closed in layers. Operative time was 139 minutes, with 26 minutes of warm ischemic time. The patient was discharged home on post-operative day 1. Creatinine four months post-operatively was 1.06 (eGFR 92) from a baseline of 0.9 (eGFR 109). Pathology demonstrated a 3.3cm clear-cell RCC with negative margins. Follow-up CT scan four months post-operatively revealed no recurrent disease, with excellent preservation of renal parenchyma and good perfusion of the kidney. CONCLUSIONS: Robotic-assisted laparoscopic anatrophic PN was effective and safe for the management of a completely endophytic renal mass in this patient. Renal parenchyma was maximally preserved while remaining adherent to principles of surgical oncology. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1229 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dylan Buller More articles by this author Ryan Dorin More articles by this author Expand All Advertisement PDF downloadLoading ...
Buller et al. (Mon,) studied this question.