V10-10: Nephron sparing surgery of a huge endophytic perihilar tumor by Video-assisted Mini Laparotomy Surgery(VAMS)
Nephron sparing surgery is currently the standard treatment for small renal mass. As the functional outcome is better than radical nephrectomy, nephron sparing surgery is more compelling when the patient has low or marginal renal function. However, in complex tumors it is challenging to perform, and a minimally invasive surgery may not be feasible. We here present a case of nephron sparing surgery for a highly complex renal tumor, utilizing Video-assisted Mini-laparotomy Surgery(VAMS).
VAMS is performed as we have previously reported. A 7 cm incision is made on the antero-lateral abdomen. (Fig 1, left down) The retroperitoneal space is dissected and VAMS retractors are used to secure the surgical space, and a video system is placed through the incision. (Fig 1, right) Then conventional instruments used in open and laparoscopic surgery are utilized to perform nephron sparing surgery.
A 47-year-old male patient presented with an incidental renal tumor. CT scan revealed a 5cm hypervascular mass on the left kidney. (Fig 1, left up) The mass was fully endophytic, abutting the hilum. R.E.N.A.L nephrometry score was 11xh. Preoperative serum creatinine was 1.20 mg/dL with an estimated GFR of 65 ml/min/1.73 m². VAMS nephron sparing surgery was performed. Total operation time was 153 min and warm ischemic time was 25 min. Pathology reported clear cell renal cell carcinoma with Fuhrman grade 3, and resection margin was free from carcinoma. The patient was discharged 8 days after surgery without complication. After 1 month, serum creatinine was 1.23 mg/dL with an estimated GFR of 63 ml/min/1.73 m² which was equivalent to the preoperative level.
Nephron sparing surgery for highly complex renal tumors can be safely performed by Video-assisted Mini-laparotomy Surgery(VAMS). While it is a minimally invasive surgery, it is convenient as conventional open and laparoscopic instruments which are familiar to the operator may be used with a high degree of freedom. This allowed the complicated surgery to be feasible and less challenging.