V07-02: Robotic Nephron-Sparing Surgery for Moderate and High Complexity Tumors in Solitary Kidneys with Renal Artery Cold Perfusion Technique
Performing nephron-sparing surgery (NSS) for complex renal tumors remains difficult because of longer warm ischemia time and more demanding techniques. The objective of this study is to introduce our technique and discuss the results of robotic NSS with renal artery cold perfusion (RACP) for moderate and high complexity tumors in solitary kidneys.
Twelve patients with moderately and highly complex tumors in solitary kidneys who underwent robotic NSS with RACP were retrospectively analyzed. A double lumen balloon-tipped angio-catheter was passed preoperatively into the renal artery through a femoral puncture. The renal artery was occluded with an intraluminal balloon. Ringer lactate at 4° was continuously perfused into the kidney and drained through the gonadal and renal veins. Renal parenchymal temperatures were monitored. Tumor resection and renorrhaphy were completed with cold ischemia. Data on ischemia time, renal temperature, blood loss, renal function, complications, and pathology parameters were collected.
All cases were treated via robotic surgery, and no conversion to open surgery occurred. In 11 cases, partial nephrectomy was successfully performed. One patient was converted to radical nephrectomy due to venous invasion. Median renal tumor diameter was 5.8 cm (IQR: 2.7 to 8.4). Median renal nephrometry score was 10 (IQR: 9 to 11). Median cold ischemia time was 55 minutes (IQR: 40 to 90). A median nadir renal core temperature of 24.2° (IQR: 23.1 to 25.2) was achieved in all Patients. Renal function was decreased by 28.5% and 26.1% at three months and latest follow-up, respectively. No patient had chronic renal insufficiency at three months post-operation. No patient required dialysis. No patient showed complications greater than CDS grade 3. One patient was found to have local recurrence 43 months after surgery by MRI examination. The disease-specific survival rates were 100% in our cohort during the median follow-up of 18.5 months (IQR: 13.5 to 35.3). Limitations of the study include the retrospective nature, small sample size, and short follow-up time.
Our experience demonstrated that robotic-assisted NSS with RACP for moderate and high complexity tumors in solitary kidneys is effective, safe, and technically feasible. This approach is a promising technique, and provides an alternative approach to open surgery with the benefits of minimally invasive surgery. It also facilitates the identification and repair of injured vessels and collecting systems in a blood-free field.