Mediathek

Abstract

P. Sparwasser¹, M. Haack¹, G. Duwe¹, M.P. Brandt¹, R. Mager¹, A. Haferkamp¹, I. Tsaur^1
1Universitätsmedizin Mainz, Urologie, Mainz, Deutschland

Introduction: In case of location anomaly of the kidney with suspicious for a malignant renal cell carcinoma there are no standardized robotic-assisted procedures predefined. Therefore, many institutions still perform common open surgery hazarding the consequences of greater postoperative morbidity. We demonstrate a feasible approach for robot-assisted transperitoneal partial nephrectomy for a complex renal cell carcinoma of a right-sided ectopic pelvic kidney.

Methods: Indication for partial nephrectomy for a 57-year-old female (BMI 31.2; ASA II) was based on Ct-graphic finding of a localized 3.0x2.5cm renal mass of the right pelvic kidney with 2 arteries (R.E.N.A.L Score 7 [intermediate risk]; posterior localization, endophytic). We scheduled the patient for robot-assisted partial nephrectomy (DaVinci Xi, INTUITIVE) with intraoperative ultrasound. We set up a transperitoneal approach with a four robotic arm configuration plus two assistant ports 4 cm above the umbilicus.

Results: Surgical time was 205min, incl. console time of 170min with an estimated blood loss of 200cc. No intraoperative limitations were observed due to the robotic approach (ischemia time: 13min). No intraoperative (EAUiaiC) and postoperative (Clavien Dindo ≥3a) complications were observed. Bladder catheter and intraperitoneal drain were removed at the 2nd day. We discharged the patient on the 4th postoperative day without 30-day readmission. The first short-term Follow-up demonstrated no relapse of the detected clear cell renal carcinoma (TNM: pT1a,pNx,L0,V0,Pn0,R0).

Conclusion: The transperitoneal robot-assisted approach for partial nephrectomy is even for challenging tumor localization of a renal cell carcinoma in ectopic pelvic kidney well feasible and reduces postoperative morbidity.