V5-05: Salvage Robotic Partial Nephrectomy After Failed Cryo-ablation
Partial nephrectomy is the gold standard for treating patients with suspicious renal lesions. More_x000D_ recently, ablative the technologies have come into vogue as a minimally invasive means to address the mall_x000D_ renal mass. In this video, we demonstrate our technique for a salvage partial nephrectomy in a case of failed_x000D_ cryo-therapy for suspected renal cell carcinoma.
The case a is a 49 year old male who in 2011 had a cryo-ablation of a left upper pole renal mass in conjunction with a left sided laparoscopic bowel resection for cancer. Follow up MRI in 2015 demonstrated a bilobar mass in the postero-medial aspect of the left kidney- the previous site of cryo-therapy. The mass had_x000D_ a non-enhancing exophytic component (previously ablated) as well as an enhancing endophytic region suspicious for RCC. He was taken to the operating room for a partial nephrectomy, and his chart was pulled and retrospectively examined.
Operative time was just over 2 hours with an estimated blood loss of 50cc, and an ischemia time of 27 minutes. Post-operatively the creatinine was 1.1 with a length of stay of 2 days. Most recent creatinine was 1.0 and pathology showed and area of ablated tissue (exophytic lesion) adjacent to the endophytic lesion which demonstrated clear cell type renal cell carcinoma.
In an era of new modalities for addressing the small renal mass, partial nephrectomy may be utilized for salvage procedures when new technologies fail. We suggest considering 3D imaging and virtual_x000D_ surgical planning to help define boarders and approach, as well as to define surgical feasibility. Meticulous intra-operative ultrasonography is also crucial. Finally, when feasible, tissue planes should be exploited so the tumor can be peeled of the collecting system