How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor
ABSTRACT Purpose: The conservative management of localized renal masses has been recently widened to cT2 tumors showing encouraging functional and oncological outcomes (1). This video aims to report the conservative management of a highly complex renal tumor treated with robotic pure enucleation in...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Sociedade Brasileira de Urologia
2020-07-01
|
| Series: | International Brazilian Journal of Urology |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382020000500871&tlng=en |
| _version_ | 1798020732402270208 |
|---|---|
| author | Andrea Minervini Antonio Andrea Grosso Fabrizio Di Maida Andrea Mari Gianni Vittori Gianluca Muto Marco Carini |
| author_facet | Andrea Minervini Antonio Andrea Grosso Fabrizio Di Maida Andrea Mari Gianni Vittori Gianluca Muto Marco Carini |
| author_sort | Andrea Minervini |
| collection | DOAJ |
| description | ABSTRACT Purpose: The conservative management of localized renal masses has been recently widened to cT2 tumors showing encouraging functional and oncological outcomes (1). This video aims to report the conservative management of a highly complex renal tumor treated with robotic pure enucleation in our center, specifically focusing on preoperative work-up, video-reported surgical steps and perioperative outcomes. Materials and Methods: A 63 year-old lady underwent CT scan revealing a single 75 x 68mm, mainly endophytic, right renal mass dislocating the vascular pedicle (cT3a). Two renal arteries and two veins were identified. PADUA, RENAL and simplified SPARE scores were 14a, 12a and 12 respectively. Since the contralateral kidney was hypotrophic, the indication for nephron-sparing approach was considered absolute. Preoperative surgical planning included the employment of 3D-virtual models (2). Results: Operative time was 150 minutes and warm ischemia time was 25 minutes. No major complication occurred. Histopathological analysis revealed a cromophobe renal cell carcinoma with extension to perirenal fat tissue (pT3a). Resection technique was classified as pure enucleation since Surface-Intermediate-Base (SIB) score was 0-0-0 (3, 4). At seven-months follow-up no signs of local or systemic recurrence were recorded. Postoperative CT-scan revealed optimal parenchymal volume preservation with last creatinine blood level of 1.16mg/dL. Conclusion: This video highlights how, in experienced hands, robotic partial nephrectomy represents a feasible, effective treatment option for surgical management of highly complex renal tumors. The employment of intraoperative ultrasonography and 3D-virtual models allowed to accurately tailor surgical approach, improving the perception of tumor anatomy and its vascularization and maximizing perioperative outcomes. |
| first_indexed | 2024-04-11T17:02:24Z |
| format | Article |
| id | doaj.art-41aaf53a027443d2bbf845bad0de770f |
| institution | Directory Open Access Journal |
| issn | 1677-6119 |
| language | English |
| last_indexed | 2024-04-11T17:02:24Z |
| publishDate | 2020-07-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-41aaf53a027443d2bbf845bad0de770f2022-12-22T04:13:07ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-61192020-07-0146587187210.1590/s1677-5538.ibju.2020.0059How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumorAndrea MinerviniAntonio Andrea Grossohttps://orcid.org/0000-0001-5973-789XFabrizio Di MaidaAndrea MariGianni VittoriGianluca MutoMarco CariniABSTRACT Purpose: The conservative management of localized renal masses has been recently widened to cT2 tumors showing encouraging functional and oncological outcomes (1). This video aims to report the conservative management of a highly complex renal tumor treated with robotic pure enucleation in our center, specifically focusing on preoperative work-up, video-reported surgical steps and perioperative outcomes. Materials and Methods: A 63 year-old lady underwent CT scan revealing a single 75 x 68mm, mainly endophytic, right renal mass dislocating the vascular pedicle (cT3a). Two renal arteries and two veins were identified. PADUA, RENAL and simplified SPARE scores were 14a, 12a and 12 respectively. Since the contralateral kidney was hypotrophic, the indication for nephron-sparing approach was considered absolute. Preoperative surgical planning included the employment of 3D-virtual models (2). Results: Operative time was 150 minutes and warm ischemia time was 25 minutes. No major complication occurred. Histopathological analysis revealed a cromophobe renal cell carcinoma with extension to perirenal fat tissue (pT3a). Resection technique was classified as pure enucleation since Surface-Intermediate-Base (SIB) score was 0-0-0 (3, 4). At seven-months follow-up no signs of local or systemic recurrence were recorded. Postoperative CT-scan revealed optimal parenchymal volume preservation with last creatinine blood level of 1.16mg/dL. Conclusion: This video highlights how, in experienced hands, robotic partial nephrectomy represents a feasible, effective treatment option for surgical management of highly complex renal tumors. The employment of intraoperative ultrasonography and 3D-virtual models allowed to accurately tailor surgical approach, improving the perception of tumor anatomy and its vascularization and maximizing perioperative outcomes.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382020000500871&tlng=en |
| spellingShingle | Andrea Minervini Antonio Andrea Grosso Fabrizio Di Maida Andrea Mari Gianni Vittori Gianluca Muto Marco Carini How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor International Brazilian Journal of Urology |
| title | How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor |
| title_full | How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor |
| title_fullStr | How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor |
| title_full_unstemmed | How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor |
| title_short | How far is too far? Exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor |
| title_sort | how far is too far exploring the indications for robotic partial nephrectomy in a highly complex kidney tumor |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382020000500871&tlng=en |
| work_keys_str_mv | AT andreaminervini howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor AT antonioandreagrosso howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor AT fabriziodimaida howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor AT andreamari howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor AT giannivittori howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor AT gianlucamuto howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor AT marcocarini howfaristoofarexploringtheindicationsforroboticpartialnephrectomyinahighlycomplexkidneytumor |