V7-10: Robotic Trapdoor Partial Nephrectomy for Completely Endophytic Tumors

Video

Introductions and Objectives
Robotic partial nephrectomy (RPN) for entirely endophytic tumors has recently been shown to be feasible. Resecting a tumor that involves the central sinus fat at or near the hilum results in a deep cavity that may complicate the renorrhaphy due to the limited residual cortical tissue available for reapproximation. Furthermore, failure to tightly close the renal defect may increase the possibility for postoperative bleeding. We describe a novel Trapdoor RPN technique for completely endophytic tumors that utilizes a flap of renal parenchyma overlying the tumor to facilitate tight closure of the defect.

Methods
Our technique was performed in two patients by a single surgeon (DDE) between July and October 2013. After intracorporeal sonographic localization of the mass and clamping the hilum, sharp dissection was used to create our trapdoor, a “U” shaped flap of healthy parenchyma overlying the anterior surface of the tumor. The trapdoor was then propped open using a non-traumatic robotic grasping retractor, and the tumor was enucleated. Once the inner layer was closed and the hilum was unclamped, the trapdoor was closed and incorporated into the outer layer closure.

Results
For patient 1, warm ischemia time (WIT) was 39 minutes, estimated blood loss (EBL) was 200 milliliters, and console time was 125 minutes. Pathology showed a 2.5 cm T1a clear cell RCC with negative margins. For patient 2, WIT was 17 minutes, EBL was 100 millilters, and console time was 100 minutes. Pathology showed a 3.2 cm T1a clear cell RCC with negative margins. In both cases, there were no intraoperative or postoperative complications, and both patients were discharged on post operative day 1.

Conclusions
Our Trapdoor RPN technique for completely endophytic tumors utilizes a flap of renal parenchyma overlying the tumor to assist in tight closure of the defect.

Funding: None