Urology Video Journal (Jun 2022)
Open partial nephrectomy in the robotic era
Abstract
Objective: To evaluate the contemporary role of open partial nephrectomy at a referral high-volume kidney cancer Center, presenting our step-by-step technique of open tumor enucleation. Patient and Surgical Procedure: We queried our prospectively database to select patients undergoing open PN for non-metastatic renal masses at our Center between January 2017 and December 2020. Preoperative patients’ and tumors’ characteristics were recorded. Overall, open PN was performed by a single highly experienced surgeon (S.S.) (> 500 RAPN; > 500 open PN) following established principles. In this video we present a case of a 69-year-old patient with a highly complex (PADUA 10), cT2N0M0, predominantly endophytic 8 cm renal mass in a congenital right solitary kidney (preoperative eGFR 73 ml/min/1.73 m2), with no previous abdominal surgery, undergoing open PN. Results: Overall, of 428 patients treated with PN at our Center in the study period, 422 (98.6%) underwent RAPN while 6 (1.4%) open PN. There were no intraoperative adverse events. Perioperative major (Clavien-Dindo grade > 3) complications were recorded in two patients. In the case shown in the video, the overall operative time was 240 min, while warm ischemia time 35 min. The postoperative course was uneventful, and the patient was discharged on postoperative day (POD) 6 in good clinical conditions and with an eGFR of 53.7 ml/min/1.73 m2. The patient was then readmitted on POD 13 for an active bleeding from a small renal pseudoaneurysm detected by an angio-computed tomography scan. Therefore, the patient underwent super-selective embolization, and discharged four days later in good clinical conditions and with an eGFR of 49 ml/min/1.73 m2. Histopathological examination revealed a pT3a Nx ISUP grade 3 clear cell renal cell carcinoma, with negative surgical margins. Conclusions: While robotic approach has almost replaced open PN at referral high- volume Centers worldwide for localized renal masses, carefully selected patients may still benefit from an open approach.
