V10-06: X-CITE (X-Capsular Incision for Tumor Enucleation) Technique: A Novel Method for Parenchymal Preservation for Endophytic Renal Tumors
Endophytic renal tumors can be technically challenging to resect during partial nephrectomy, and often require sacrificing the normal renal parenchyma overlying the tumor. Patients with bilateral or multifocal tumors benefit from maximal parenchymal preservation. Herein, we propose a novel technique to enucleate endophytic renal tumors while preserving the overlying parenchyma.
We present a report of a case for a 27-year-old patient who presented with bilateral, 3 cm renal tumors. Because this patient may be at risk for developing future tumors, partial nephrectomy with maximal parenchymal preservation was pursued by using the X-CITE technique. An X-shaped incision in is made. The parenchyma is then split until the tumor pseudocapsule is encountered. The tumor is then enucleated away from the adjacent parenchyma. Hemostasis is obtained with a two-layer renorraphy.
Warm ischemia time was 19 minutes and EBL 100 cc. Final pathology demonstrated Fuhrman grade 2 clear cell RCC with negative margins. Patient’s postoperative course was uneventful. Change in GFR was 6 mL/min per 1.73 m2 (111 to 105). Follow up imaging demonstrated no residual tumor.
The X-CITE technique spares the overlying parenchyma while allowing circumferential mobilization of endophytic renal tumors.The technique appears to be a safe and feasible approach to remove endophytic renal tumors with little collateral damage. Further investigation is needed to identify which patients may benefit from this procedure as well as intermediate and longer-term outcome