Initial experience with robot assisted partial nephrectomy for multiple renal masses

Abstract

Purpose: We evaluated the feasibility of performing robot assisted partial nephrectomy in patients with multiple renal masses and examined the results of our initial experiences.

Materials and methods: We reviewed the records of 10 patients with multiple renal masses who underwent attempted robot assisted partial nephrectomy within the last 2 years. Demographic information, and intraoperative, perioperative and renal function outcome data on these patients were reviewed.

Results: A total of 24 tumors in 9 patients were removed with robot assistance. There was 1 open conversion with successful completion of partial nephrectomy. Of the patients 70% had a known hereditary renal cancer syndrome and the remainder had multifocal disease with unknown germline genetic alterations. Frozen section from the tumor bed evaluated in 5 of 10 cases was negative. One patient experienced urinary leak postoperatively, which resolved by postoperative day 9 without intervention. Of the 24 robotically resected masses 22 were malignant. Our most recent 3 patients underwent successful partial nephrectomy without hilar clamping, obviating the need for warm ischemia. Overall renal function was unchanged at most recent followup with a minimal decrease in operated kidney differential function.

Conclusions: Robot assisted partial nephrectomy for multiple renal masses was feasible in our early experience. Patient selection is paramount for successful minimally invasive surgery. Robot assisted partial nephrectomy without hilar clamping, especially in the hereditary patient population in which repeat ipsilateral partial nephrectomy may be anticipated, appears promising but requires further evaluation.

Figure 1

Pre-operative and post-operative CT scan in VHL patient with two large endophytic tumors. A) Pre- operative CT scan. Arrows demonstrating renal lesions B) Post-operative CT scan at 3 months demonstrating usual post operative changes.

Figure 1

Pre-operative and post-operative CT scan in VHL patient with two large endophytic tumors. A) Pre- operative CT scan. Arrows demonstrating renal lesions B) Post-operative CT scan at 3 months demonstrating usual post operative changes.

Figure 2