V10-09: Robotic Radical Nephrectomy with Partial Pancreatectomy, Splenectomy and Partial Gastrectomy for A Locally Advanced Renal Tumor
Experience with minimally invasive approaches to locally advanced renal tumors continues to evolve. We demonstrate a case of robotic radical nephrectomy with involvement of multiple adjacent organs.
In this video, we are presenting a challenging case of locally advanced renal tumor involving the tail of the pancreas, splenic hilum and the greater curvature of the stomach. Intraoperative assessment showed that the tumor was inseparable from the surrounding organs. We performed a fully robotic procedure to remove the tumor. We then proceeded with ligation and division of the splenic vein. Next, we used a stapler for resection of the tail of the pancreas together with the splenic artery. Part of the greater curvature of the stomach was stapled and resected as it was intimately involved in the tumor. The renal hilum was controlled by selective ligation and division of the artery and vein. The mass was removed enblock.
Operative time was 200 minutes. The estimated blood loss was 150 mL. The patient started regular diet after 48 hours and was discharged on post-operative day 3. Pathology report showed poorly differentiated malignant neoplasm, consistent with sarcomatoid carcinoma, with negative surgical margins.
Minimally invasive surgical management of locally advanced renal tumors involving surrounding organs is feasible and can be performed safely. The role of robotic surgery in this setting continues to evolve and may facilitate complex radical nephrectomy.