V10-11: Robotic Partial Nephrectomy for Completely Endophytic Renal Tumors
Partial nephrectomy for completely endophytic renal tumors can be challenging. Hilar location of the tumor adds more challenges and makes partial nephrectomy less likely to be considered.
In this video we present three challenging partial nephrectomy procedures for completely endophytic hilar renal tumors. Using a transperitoneal approach, we start with colon mobilization to reach the retoperitoneal space. After hilum dissection, we routinely use intraoperative ultrasonography to detect the tumor location and margins. We start resection using cold scissor with a steep angle until we reach the tumor. When the tumor is located very deep in a centeralized location, we resect a small portion of the normal renal parenchyma above the tumor and we use ultrasound guidance over the parenchymal defect to further identify the margins. Then, enucleation of the tumor is performed. Renorrhaphy is performed in two layers and early unclamping is performed to minimize warm ischemia time and further identify any bleeding vessels.
We demonstrated the feasibility of robotic partial nephrectomy for challenging completely endophytic hilar renal tumors. Our data shows that completely endophytic tumors require longer ischemia time. However, there was no increase in the early postoperative complication rate. In addition, we observed similar renal functional outcome after partial nephrectomy for completely endophytic and exophytic renal tumors.
Partial nephrectomy for completely endophytic renal tumors is not contraindicated and can be done safely. The functional outcome benefits indicate that partial nephrectomy should always be attempted. The use of intraoperative ultrasound has a crucial role in this setting.