V04-10 Tips for Technique of Robot-Assisted Salvage Partial Nephrectomy After Tumor Ablation

You have accessJournal of UrologyAdrenal/Renal Oncology I (V04)1 May 2024V04-10 TIPS FOR TECHNIQUE OF ROBOT-ASSISTED SALVAGE PARTIAL NEPHRECTOMY AFTER TUMOR ABLATION Justin Refugia and Ashok Hemal Justin RefugiaJustin Refugia and Ashok HemalAshok Hemal View All Author Informationhttps://doi.org/10.1097/01.JU.0001009444.59519.d3.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For T1 renal masses, primary management with multiple tumor ablations has similar local control rates to partial nephrectomy. However, single ablations have worse local recurrence rates that may necessitate salvage interventions that may be complicated by significant perinephric fibrosis and obliterated surgical planes. In our video, we present the case of a patient undergoing robot-assisted salvage partial nephrectomy for local recurrence after tumor ablation. METHODS: Case: 66-year-old male with with heart disease, chronic kidney disease, hypothyroidism, prior intra-abdominal surgery, and body mass index: 30 kg/m2. Patient was referred for local recurrence of left renal mass after previous laparoscopic, retroperitoneal cryoablation. He was previously evaluated by interventional radiology and deemed not safe for re-ablation. We report our single-center case series of robot-assisted salvage partial nephrectomy. RESULTS: From 2017 to 2023, we identified ten patients (Cryo, N=8; RFA, N=2) with local tumor recurrence at a median of 24- months after ablation for the index lesion (median 2.3 cm diameter). At site of prior ablation, the patient's local tumor recurrence was median 2.7 cm. Robot assisted salvage PN was performed with 22-minute median warm ischemia time after renal artery trunk clamping (one patient with artery and vein clamping) and 161-minute median operating time. Pathology was clear-cell renal cell carcinoma and with negative surgical margins for all ten patients. No 90-day C.D. complications were reported. Median follow up was 16-months and only one patient (10%) had another local recurrence at PN site 31-months post-op. CONCLUSIONS: Robot assisted salvage partial nephrectomy after ablation is feasible, safe, and oncologically effective. Complexity of salvage renal surgery may be due to significant perinephric fibrosis, irregularity of tumor recurrence, and adhesions. Tips for technique: "Hilar first" approach for early vascular control, 3-D reconstruction of cross-sectional imaging, and use of intraoperative ultrasound and indocyanine green with near-infrared fluorescence imaging. 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 Justin Refugia More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...