V7-02: Robotic Partial Nephrectomy for a Complex Hilar Mass in a 14 Year Old Boy
VideoIntroductions and Objectives
Robotic surgery still poses many challenges in pediatric patients and there has been limited use of minimally invasive approaches for treatment of renal masses in pediatric population. We present a case of 14 year old boy with history of recurrent urinary tract infections and bilateral hydronephrosis, who underwent bilateral pyeloplasty several years ago and presented to the emergency room after a right renal mass was seen on a follow-up renal ultrasound.
CT scan showed 4.2cm, infrahilar renal mass. Renal scan revealed a split differential function of 42% on the right and 52% on the left. Serum creatinine was 1.1. Given the patient's young age, prior history of bilateral renal surgery on both kidneys, the increased risk of CKD in the long-term and the equivalent oncologic efficacy of partial vs. radical nephrectomy, we considered nephron-sparing surgery. Plan was for a Robotic Right Partial Nephrectomy with intraoperative ultrasonography. If partial nephrectomy was not deemed possible, we would have proceeded with radical nephrectomy
We were able to successfully perform Robotic partial nephrectomy without any complications. Pathology revealed Renal cell carcinoma, unclassified type, 5.5 x 5.4 x 3.4 cm (High Grade). Postoperative creatinine was 1.3. Surgical resection margins were negative for tumor. Patient was discharged on postoperative day 4.
Robotic partial nephrectomy is feasible in complex hilar mass and in pediatric population. It should be attempted if nephron sparing is indicated.