V3-10: Robotic-assisted laparoscopic nephrectomy of an auto-transplanted kidney for recurrent renal cell carcinoma
Advances in robotic technology continue to expand the boundaries of minimally invasive renal surgery for both benign and malignant conditions. A single report has previously described the use of the robotic approach in transplant nephrectomy for a failed allograft. _x000D_ Herein, we present the first robotic-assisted laparoscopic nephrectomy of an auto-transplant kidney for a tumor recurrence, in a unique case of a solitary kidney that had previously undergone ex vivo partial resection for a complex renal cell carcinoma.
The patient is a 64-year-old man with a history of a solitary left kidney after a radical right nephrectomy several years ago for a clear cell renal cell carcinoma. After discovery of a new centrally located left renal mass on surveillance, he underwent nephron-sparing surgery by laparoscopic nephrectomy followed by ex vivo partial nephrectomy and auto-transplant to the right iliac fossa. He subsequently developed a recurrence near the renal pelvis which was initially stable for four years on tyrosine kinase inhibitor therapy. The tumor then increased in size after therapy was discontinued due to toxicity. He was counseled on his surgical options for a radical auto-transplant nephrectomy and elected for a robotic approach. The procedure was completed transperitoneally using the da Vinci Si Surgical System. The patient was positioned supine with the robot side-docked over the right iliac fossa. Three robotic arms were utilized in addition to two assistant ports.
The total operative time was 387 minutes with an estimated blood loss of 800 mL. The patient received 2 units of packed red blood cells intraoperatively. The patient had an unremarkable postoperative course and was discharged on day 3. There were no perioperative complications. Pathology revealed recurrent 8.2cm clear cell renal cell carcinoma, Grade IV involving the renal vein with negative surgical margins.
Robotic transplant nephrectomy has previously been shown to be safe and feasible in the management of a failed allograft. We report on our technique and experience with the additional technical demands of a previously operated auto-transplant kidney. A minimally-invasive approach can potentially reduce the morbidity of this uncommon and complex procedure. _x000D_