Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis

Abstract

Purpose: Laparoscopic partial nephrectomy is an advanced surgical procedure requiring technical skill in minimally invasive techniques. Tumors located adjacent to the renal hilum pose an additional challenge. We report a multi-institutional study of robotic partial nephrectomy for renal hilar tumors and describe our results.

Materials and methods: We evaluated patients from 2 institutions who underwent robotic partial nephrectomy for renal hilar tumors. Renal hilar tumors were defined as tumors abutting the renal artery and/or renal vein on preoperative imaging. After clamping the renal hilar vessels tumors were excised with fine dissection from the renal vessels followed by sutured renal reconstruction.

Results: Robotic partial nephrectomy was successfully performed on 11 patients (mean age 56.4 years, range 30 to 76). Mean tumor size was 3.8 cm (range 2.3 to 6.4). Mean warm ischemia time was 28.9 minutes (range 20 to 39) and mean operating time was 202 minutes (range 154 to 253). Mean blood loss was 220 ml (range 50 to 750). Mean hospital stay was 2.6 days (range 1 to 4). Histopathological evaluation confirmed 8 cases of clear cell renal cell carcinoma, 1 of papillary renal cell carcinoma and 2 of chromophobe renal cell carcinoma. Surgical margins were negative for malignancy in all cases.

Conclusions: Robotic partial nephrectomy is a safe and feasible approach for select patients with renal hilar tumors. Robotic assistance may facilitate tumor resection and renal reconstruction for challenging renal hilar tumors, offering a minimally invasive and nephron sparing surgical option for select patients who might otherwise require open surgery or total nephrectomy.

Fig 1

Posterior renal hilar tumor. Coronal CT demonstrates a 2.6 cm solid tumor located near the left renal vessels and abutting the renal pelvis.

Fig 2a

Large anterior renal hilar tumor. CT demonstrates a right 6.4 cm solid mid/upper pole renal mass.

Fig 2b

Coronal view of same tumor (black arrow) demonstrating proximity to renal hilar vessels (white arrow).

Fig 3a

Port configuration for robotic partial nephrectomy utilizing medial camera port. Ports include a periumbilical camera port, robotic instrument ports in a V configuration toward the kidney tumor, and an infraumbilical 12 mm assistant port.

Fig 3b

Port configuration for robotic nephrectomy utilizing a lateral camera port, fourth robotic arm, and medial 12 mm assistant port.