V1082: Robotic Partial Nephrectomy for Bilateral Tumors: Decisions, Techniques, & Outcomes
VideoIntroduction and Objectives
Nephron-sparing approaches are preferred in patients with worrisome bilateral renal neoplasms in effort to control malignancy and prevent progression to dialysis. The optimal approach to such cases in terms of which kidney to manage first is unknown. New advances in robotic partial nephrectomy technique such as the use of indocyanine green and clipping of tumor vessels with absorbable clips show promise in the performance of unilateral partial nephrectomy but have not been extensively evaluated in bilateral cases. We hypothesized that a management approach incorporating surgery of the kidney at the highest-risk of becoming a solitary kidney first and use of new operative techniques would minimize renal functional decline and allow for acceptable oncologic control for patients undergoing bilateral robotic partial nephrectomy.
We reviewed the clinical course of eight consecutive patients who underwent staged robotic bilateral partial nephrectomies at out institution. Renal functional paramaters, peri-operative course, and histopathologic data were gathered and analyzed with descriptive statistics. An index patient with eight renal masses and Birt-Hogg Dube syndrome was used to construct a video describing our decision-making, operative technique, and outcomes.
Eight consecutive patients underwent staged bilateral robotic partial nephrectomies for a median of 3 masses that were 3.3 cm in diameter. Overall renal function decline was 18% across both surgeries without progression to dialysis in any patient. Fifty percent of patients had discordant histology between sides.
Staged bilateral robotic partial nephrectomies are a safe and feasible method of managing bilateral renal masses. An approach involving the initial management of the kidney at highest-risk of becoming a solitary kidney can successfully control malignancy while preventing progression to dialysis.