Mediathek

Abstract

Robotic assisted partial nephrectomy in a central totally intraparenchymal kidney tumour

J.-U. Stolzenburg¹, V.K.A. Arthanareeswaran¹, D. Thomalla^1
1Universitätsklinikum Leipzig, Leipzig, Deutschland

Introduction: Recent publications have shown that partial nephrectomy (PN) can be a safe treatment option even for complex tumours that would otherwise undergo a radical nephrectomy. Careful pre/intra-operative planning is crucial for these complex operations. In this video we present our experience in managing a patient with a central, completely intraparenchymal kidney tumour with the help of cognitive 3D guidance.
Materials and methods: A 69 year old male patient presented with newly diagnosed microhematuria. MRT abdomen revealed a 3 cm central kidney tumour on the left side. A 3D model was reconstructed using the MRT images. We demonstrate our robot assisted surgical technique of PN.
Results: The patient was placed on a right lateral position. The trocars were placed in a typical manner for transperitoneal PN. The Gerota's fascia was opened and the hilus was dissected. The kidney was completely mobilized following looping of renal vessels. Cognitive fusion based on 3D model and intraoperative ultrasound was used to locate the tumour and mark the resection margins. The tumour was enucleo-resected successfully and the frozen section revealed tumour free margins of a hypernephroma. Haemostasis was achieved by inner layer renorraphy suturing along with placement of haemostatic agents at the end of the procedure.
Conclusion: Robot assisted PN is feasible even in case of totally intrarenal tumours. The maneuverability and flexibility of the DaVinci instruments along with ultrasound and 3D cognitive guidance helps the surgeon to perform these fine steps precisely.