V9-07: Robotic partial nephrectomy during pregnancy: case report and special considerations
To present a case of robotic partial nephrectomy (RPN) during pregnancy and review special considerations for perioperative management and laparoscopic/robotic surgery during pregnancy.
A 35 year-old pregnant woman at 20 weeks gestation was found incidentally to have a large right renal mass during routine prenatal anatomic ultrasound. Upon further workup, the lesion was determined to be a 6.5 cm right upper-pole solid enhancing renal mass concerning for malignancy, without evidence of local extension or metastases. Ultimately, after shared decision-making between the patient and her physicians, the patient elected to proceed with RPN, for which she was deemed an appropriate candidate. A multi-disciplinary approach to her care was undertaken perioperatively in order to optimize the outcome. Notably, coordination between high-risk maternal fetal medicine (MFM), obstetrics (OB), anesthesia and urology was paramount to this endeavor.
The patient was seen and assessed by OB and MFM preoperatively, and fetal heart tones were monitored immediately before and after surgery and every day during her hospitalization. Total operating time was 253 minutes with an estimated blood loss (EBL) of 120 cc. Warm ischemia time was 36 minutes, and 70% of normal renal parenchyma was preserved after resection of the tumor. The patient’s creatinine peaked at 0.81 mg/dL, and her hemoglobin nadired to 9.6 g/dL. She was discharged on post-operative day 6 in excellent condition. Final pathology demonstrated a 6.6 cm chromophobe renal cell carcinoma with negative margins.
RPN during pregnancy is feasible but requires perioperative planning, multidisciplinary coordination of care, and careful operative decision-making to ensure optimal safety of mother and fetus. Herein, we demonstrate the first described case of RPN for renal neoplasm during pregnancy and outline current guidelines.