V03-11: Concurrent Robotic Partial Nephrectomy and Pyelolithotomy: Tips And Tricks
With the advancements of robot-assisted surgery in the urology field, this technology is being applied to treat many genitourinary conditions. Despite the fact that incidence of urolithiasis and renal neoplasm are rising, encountering both entities in a single kidney is noteworthy. Our video exhibits the concurrent management of a renal calculus and an ipsilateral renal neoplasm using a robotic platform.
A 53-year-old male was diagnosed with a 1.7cm left renal pelvis calculus and a 4.7cm enhancing ipsilateral upper pole renal mass (R.E.N.A.L nephrometry score 2+1+3+a+2=8a) after an episode of acute left flank pain. After reviewing preoperative imaging, a single setting approach using a robotic platform was planned. Main steps of our robotic technique on the case included 1) hilum dissection, 2) Kidney defatting and mobilization, 3) ureter dissection up to the renal pelvis, 4) Intraoperative ultrasound for tumor demarcation and stone localization, 5) Anterior pyelolithotomy using two robotic arms, 6) Double J stent placement and pyelotomy closure, 6) Excision of renal mass, and 7) Renorraphy. Perioperative outcomes including operative time, pathology, and length of stay were recorded.
The operative time was 180 minutes and the estimated blood loss was 100ml. Warm ischemia time was 17 minutes. There were no intra o postoperative complications. The patient was discharged home in postoperative day 3. Final pathology reported a 3.4cm mass consistent with a Clear cell renal cell carcinoma, with a TNM staging pT1aNx and negative surgical margin. The double J stent was removed after 4 weeks and the patient remains asymptomatic at 1 month postoperatively.
Robotic partial nephrectomy and pyelolithotomy can be performed effectively when treating patients with concurrent renal stone and a kidney mass using the same surgical access. This minimally invasive approach should be contemplated as an option when managing patients with both conditions in an ipsilateral kidney. Furthermore, it will diminish the necessity of various surgeries while preserving renal function and maintaining oncological outcomes.