V9-12: Robot-assisted Laparoscopic Resection of Renal Vein Leiomyosarcoma
Leiomyosarcoma (LMS) arising from the renal vein is very rare, with less than 40 cases reported in the literature. Since the initial description of this disease entity in 1967, nearly all cases have been managed with open resections, often with significant associated morbidity. Herein we describe a minimally invasive, robotic approach to resection of this aggressive retroperitoneal tumor.
With patient in a modified left flank position, we employ a 6-port trans-peritoneal configuration (including use of a 4th arm) in a similar fashion to standard robotic partial nephrectomy. Using this approach, we demonstrate resection of a large left renal vein LMS with en-bloc radical nephrectomy. Key steps critical to the procedure include: 1) Exposure of the retroperitoneum and mass 2) Early identification and preservation of vital associated vascular structures (with particular focus on careful control of regional lymphatic channels) 3) Identification and division of the renal hilum, and 4) Wide resection of the mass with nephrectomy/adrenalectomy. Pathologic findings are described. Peri-operative outcomes are reported along with a comparison to contemporary case reports.
Robotic resection of mass with en-bloc radical nephrectomy was performed successfully. Operative time was 420 minutes with an estimated blood loss of 500 cc, without any intra-operative complications. The tumor measured 6 x 5 x 5 cm and was noted to be densely adherent to the Superior Mesenteric Artery, Celiac Trunk, and anterolateral surface of the Aorta, requiring a meticulous dissection. The robotic approach allowed for a safe, controlled dissection of the mass from these critical vascular structures in a minimally invasive fashion. Pathologic review demonstrated an LMS arising from the left renal vein. Length of hospital stay was 3 days. No major 90-day complications were observed.
We demonstrate robotic resection of a left renal vein LMS, which is the largest reported primary renal vein LMS managed by a minimally invasive approach to date. We show that robotic resection of renal vein LMS is feasible in appropriately selected patients. _x000D_