V5-02: Complex Robotic Partial Nephrectomy for Hilar Masses
VideoIntroductions and Objectives
Robotic partial nephrectomy is performed increasingly for complex renal masses. We present technique of addressing a right posterior hilar renal mass abutting the collecting system, as well as the renal hilum. Our objective was to demonstrate our technique for dissection and extirpation of a hilar mass using the robotic-assisted laparoscopic approach.
The patient was diagnosed with a three centimeter posterior hilar mass found incidentally on a computerized tomography scan. The RENAL nephrometry score for the mass was 9h, demonstrating the significantly complex nature of the lesion. The video demonstrates our technique used to dissect the mass from the hilum and safely reconstruct the kidney without inadvertent injury to the adjacent structures.
Following dissection of the renal artery and vein, the kidney is mobilized in its entirety to align the posterior hilar mass to optimize reconstruction. Dissection into the renal sinus is performed off clamp. In our experience with hilar lesions, only the renal artery is clamped while the renal vein remains open throughout the procedure. Reconstruction of the kidney is performed with care not to obstruct the renal pelvis post operatively.
Robotic-assisted laparoscopic partial nephrectomy is a safe and feasible option for the treatment of complex renal masses including hilar tumors.