V9-01: Robotic partial nephrectomy for multiple renal tumors

Video

Introductions and Objectives
Robotic partial nephrectomy (RPN) in the setting of multiple renal tumors presents unique challenges. While previous reports have documented its feasibility, loner median operative times and length of stay have also been noted. In this video, we present key steps of performing robotic partial nephrectomy in multiple renal tumors.

Methods
In this video, we show footage from different cases to highlight the four key areas in RPN for multiple renal tumors. First, we show the use of 4th arm for kidney retraction, allowing two-handed renal hilar dissection, followed by adequate kidney mobilization for providing optimal tumor exposure. Next, intraoperative ultrasound may be used for accurate anatomical identification of margins. Finally, we show techniques of on-demand ischemia, selective clamping, early unclamping, and cooling the kidney using ice to minimize ischemic damage to the kidney.

Results
From 2008 to 2014, 30 patients underwent RPN for multiple renal tumors at our institution (Table 1). The mean size of the index tumor was 2.8 cm, and the RENAL nephrometry score was 8. Acceptable operating and warm ischemia times and estimated blood loss were achieved. There were two episodes of intraoperative bleeding. Focal positive surgical margins were seen in two patients who underwent tumor enucleation, one for hereditary papillary renal cell carcinoma (RCC) and the other for sporadic RCC. Both the patients were free of recurrence at two years follow-up

Conclusions
We present one of the largest single-center case series for multiple renal tumors exclusively undergoing RPN. Judicious use of the 4th arm, greater mobilization of the kidney for tumor exposure, use of the intraoperative ultrasound, and clamping modifications to reduce ischemic damage to the kidney may facilitate RPN in the setting of multiple tumors.

Funding: None