V9-03: ROBOTIC PARTIAL NEPHRECTOMY FOR HILAR TUMORS
Hilar tumors are challenging due to their centrality and proximity to the renal hilum, increasing the complexity of tumor excision and renal reconstruction. We sought to highlight these challenges and demonstrate techniques for successful execution and excellent outcomes.
Using our retrospective robotic partial nephrectomy database, we abstracted data on patients who were treated between 2006 and 2015. Videos demonstrating robotic partial nephrectomy for two particularly challenging hilar tumors were selected for presentation. For all cases, patients were positioned in full 45-degree flank, and surgery was performed with four working ports. Intraoperative ultrasound was used to identify tumor margins and guide excision. The renorrhaphy was performed in a minimum of two layers, including a deep layer closed with 2-0 polyglactin 910 in a running fashion and a capsular layer closed with 0 polyglactin 910 suture in a horizontal mattress fashion.
Of 1123 total operations, 97 (8.9%) were performed for hilar tumors. Median tumor size was 3.7 cm (IQR, 3.0-4.6), and median RENAL score was 9 (IQR, 8-10). Median estimated blood loss was 200 cc (IQR, 100-300). Median operative and warm ischemia times were 3.3 hours (IQR, 2.7-4.3) and 26 minutes (IQR, 21-33), respectively. The overall complication rate for all tumors was 22.2% (249/1,123), including 183 (16.3%) minor and 66 (5.9%) major complications. For hilar tumors, the complication rate was 30.9% (30/97), including 21 (21.6%) minor and 9 (9.3%) major complications.
Robotic partial nephrectomy is technically feasible for highly complex hilar tumors. Operative times and warm ischemia may be prolonged. For select cases, clinical, oncological, and functional outcomes are excellent.