Off-clamp robot-assisted partial nephrectomy for high nephrometry score renal tumor

Abstract

INTRODUCTION: Zero ischemia robotic partial nephrectomy is considered a challenging procedure. The video shows the feasibility of zeroischemia robot-assisted PN in high nephrometry score renal masses.
METHODS: A 40 years old woman was admitted to our department for a 6 cm right renal tumor predominantly endophytic. Padua Nephrometry score was 12. Preoperative sCreatinine was 0.87, preoperative eGFR was 77. A transperitoneal approach was used. The right kidney was isolated and flipped to allow circumferential exposure of the tumor. A cuff of fatty tissue was preserved to facilitate exposure of the mass. Renal parenchyma was incised and a dissection plane between healthy renal parenchyma and the tumor was found. During dissection specific vascular branches supplying the tumor were identified and treated with electrocautery.A point specific hemostasis was performed and defined areas of bleeding were identified and sutured.
RESULTS: Operative time was 120 minutes. Estimated blood loss was 300 cc. No intraoperative and postoperative transfusions were necessary. The patient was discharged 3 days after surgery. sCreatinine and eGFR at discharge were 1mg/dl and 67ml/min, respectively.
CONCLUSIONS: Off-clamp PN in high nephrometry score renal masses is feasible at tertiary referral centres. Further studies are necessary to evaluate the easy reproducibility of this procedure.