V2159: Robot-assisted laparoscopic simple enucleation of an intraparenchymal hilum abutting renal tumor
VideoIntroduction and Objectives
We present our surgical technique for Intraparenchymal RCC hilum abutting tumors to show advantages of robot-assisted Simple Tumour Enucleation (TE)
We show our surgical technique for the treatment of completely intraparenchymal hilum abutting tumor in a 39 years old patient, with incidental diagnosis of 4cm left RCC.
A 12mm trocar, two 8mm robotic trocars, a 8mm and a 10mm trocars for the bedside assistant are placed. After Da Vinci© docking, the kidney is completely separated from the perirenal fat to exclude satellite lesions not detected by the imaging technique; the renal pedicle is carefully isolated and the artery is selectively clamped before TE. Then the kidney capsule is sharply incised starting a few millimeters away from the lesion toward the peritumoral capsule; when the pseudocapsule is reached the tumor is enucleated by blunt dissection and scissors using the natural cleavage plane between the pseudocapsule and normal parenchyma. Adopting sliding clips technique, on the bed of resection bleeding vessels and openings in the collecting system are closed using a 3-zero monofilament running sutures. Then the artery is early declamped and the capsular sutures is performed with horizontal interrupted sutures of 2-0 Vicryl filament, apposing hemostatic agents.
Above all we performed 108 robotic assisted TE between 2011-2012 for RCC.
Operation time: 140min. WIT: 17min. Intraoperative blood loss: 200cc. Length of hospital stay: 4 Days Creatinine serum III p.o. day: 0,91mg/dL. Pathologic outcome: Clear Cell RCC Fuhrman G2 3,5x3cm. Negative surgical margins. No evidence of tumour diffusion in peritumoral adipose tissues. pT1a pNx pMx
In case of intraparenchymal hilar tumours, thanks to image magnification and endo-wrist © movements, the Da Vinci Surgical System allows to perform TE in a feasible and safe manner.