V9-03: Robotic Enucleo-Resection of Small Renal Masses: A Safe and Oncologically Sound Alternative to Traditional Partial Nephrectomy
VideoIntroductions and Objectives
Nephron-sparing surgery is the standard of care for treatment of renal masses when technically feasible. Renal masses develop a fibrous pseudocapsule around themselves, leaving a plane that can be exploited. Enucleation techniques have previously been described via open techniques to maximally preserve normal renal parenchyma._x000D_ _x000D_ Our objective is to describe a robotic-assisted laparoscopic enucleo-resection (RALER) technique for the treatment of small renal masses.
Between 3/2012 and 1/2014, 42 RALER procedures were performed on patients with small renal masses. All patients had a mass radiologically suspicious for malignant neoplasm. Pre- and post-operative imaging and serum creatinine levels were obtained. _x000D_ _x000D_ Positioning and port placement arranged as for traditional partial nephrectomy. After achieving renal vascular control, the renal capsule is incised and the plane between the renal parenchyma and tumor pseudocapsule developed. As demonstrated in the figure, a) The tumor is identified (white asterisk) and the margin closest to the camera delineated for the initial incision (white dotted line). b) Following incision with cold scissors, the tumor pseudocapsule is identified (white asterisk) and separated from normal renal parenchyma (black plus sign). C) As the tumor pseudocapsule (white asterisk) is freed from renal parenchyma, the tumor can be rolled out of the tumor bed (black plus sign). d) Once the tumor is removed, hemostatic agents are applied to the tumor bed and manual pressure is held with the robot for five minutes. Renorraphy may be performed, but not necessary if bleeding is controlled.
All 42 RALER procedures were completed robotically. The mean patient age was 60 years (standard deviation (SD) 12), with a mean BMI of 34.3 (SD 6.7). Radiographic mass size was 2, p>0.05)._x000D_ _x000D_ Limitations include small sample size and short follow up.
RALER is a safe and oncologically sound approach to small renal mass excision. This technique is maximally renal sparing as there is no resection of normal renal parenchyma and can be performed off clamp.