V14-12 Technical Tips of an Off-Clamp Robot Assisted Partial Nephrectomy for an Endophytic Endosinusal Tumor

You have accessJournal of UrologyAdrenal/Renal Oncology II (V14)1 May 2024V14-12 TECHNICAL TIPS OF AN OFF-CLAMP ROBOT ASSISTED PARTIAL NEPHRECTOMY FOR AN ENDOPHYTIC ENDOSINUSAL TUMOR Abderrahmane Khaddad, Gaëlle Margue, Eric Alezra, Vincent Estrade, Peggy Blanc, Grégoire Capon, Franck Bladou, Grégoire Robert, and Jean-Christophe Bernhard Abderrahmane KhaddadAbderrahmane Khaddad , Gaëlle MargueGaëlle Margue , Eric AlezraEric Alezra , Vincent EstradeVincent Estrade , Peggy BlancPeggy Blanc , Grégoire CaponGrégoire Capon , Franck BladouFranck Bladou , Grégoire RobertGrégoire Robert , and Jean-Christophe BernhardJean-Christophe Bernhard View All Author Informationhttps://doi.org/10.1097/01.JU.0001008704.74547.03.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted conservative surgery for kidney tumours is gaining ground, and more and more complex tumours are being handled this way. The aim of this video is to provide technical tips for minimally invasive surgery in the management of a complex endophytic endosinusal kidney tumour. METHODS: A 69 years old female had an incidental diagnosis of suspect left kidney mass of 43 mm. eGFR was 85ml/min. The tumor was endophytic endosinusale, showing a high complexity regarding PADUA and RENAL scores (13p and 11ph). First, the biopsy revealed a chromophobe renal cell carcinoma. A high quality CT scan allowed 3D modeling using segmentation by Synapse 3D software. The 3D model was used for preoperative planning and intraoperative guidance. RESULTS: The intervention started by right colonic detachment then the complete kidney release. Renal hilum dissection was made in a retrograde way, from renal parenchyma to the larger vessels. The tumor was progressively released from the hilum elements. Intraoperative ultrasound was used to identify tumor limits. An anatomical tumor devascularisation was guided by the 3D model. After sectioning the renal parenchyma in front of it, we reached the limits of the tumour to enucleate it. Hemostasis was obtained progressively using spray coag mode with monopolar scissors, then with a circumferential parenchymal running suture. We made an elective closure of the excretory tract wounds, which was verified by a water tight test. The tumor bed was filled by an haemostatic agent and the remaining parenchyma perfusion was checked by intravenous injection of indocyanine green. Operative time was 221 mins and estimated blood loss around 600ml. Discharge was at day 1 but the patient required antibiotics at 2 weeks for an urinary infection. Pathology report showed renal cell chromophobe carcinoma of 42 mm, tumor in contact with excision margins over 1 mm. At 6 months, there was no reccurence at the CT scan and eGFR was 80ml/min. CONCLUSIONS: Robot assisted partial nephrectomy can be an option for complex endophytic endosinusal tumors. The biopsy of those complex tumors is essential to discuss surgical management. High resolution imaging and 3D modeling allows precise pre-operative planning of the procedure and intra-operative guidance. Selective devascularization planned preoperatively can avoid total renal clamping. A water tight test is quite interesting after removal of hilar endophytic tumors. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1230 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Abderrahmane Khaddad More articles by this author Gaëlle Margue More articles by this author Eric Alezra More articles by this author Vincent Estrade More articles by this author Peggy Blanc More articles by this author Grégoire Capon More articles by this author Franck Bladou More articles by this author Grégoire Robert More articles by this author Jean-Christophe Bernhard More articles by this author Expand All Advertisement PDF downloadLoading ...