V5-01: Robot assisted laparoscopic retroperitoneal partial nephrectomy for a posterior hilar tumor and a posterior horseshoe kidney tumor

Video

Introductions and Objectives
Recent reports have demonstrated that in posterior tumors, retroperitoneal (RP) robotic partial nephrectomy (RPN) compared to transperitoneal (TP) RPN resulted in shorter operating time and length of stay without sacrificing margin status or complication rates. We present two cases utilizing RP-RPN. The first is a posterior tumor in a horseshoe kidney, which does not allow traditional mobilization and flipping of the kidney, and the second is a posterior hilar tumor in close proximity to the collecting system and renal vasculature.

Methods
The first case is a 1.8 cm mass in the posteromedial aspect of the left renal moiety of a horseshoe kidney with a preoperative R.E.N.A.L. nephrometry score of 5P. The second case is a 2.2 cm hilar right kidney mass with a preoperative R.E.N.A.L. nephrometry score of 8PH.

Results
Total case time for the first procedure was 129 minutes. Warm ischemia time (WIT) was 16 min, and estimated blood loss (EBL) was 100mL. At discharge (Post-operative day #2) the patient’s serum creatinine was 0.87 (baseline 0.82) and at one month follow-up the creatinine was 0.95. Total case time for the second procedure was 274 minutes with WIT being 21 min and EBL being 50 mL. At discharge (post- operative day #2) the serum creatinine was 1.08 (baseline 1.26). The one month follow-up creatinine was 1.36. There were no complications in either case.

Conclusions
RP-RPN is a safe and feasible option for posterior hilar masses. For horseshoe kidneys with a posterior mass, the RP approach may be essential.

Funding: none