Robotic radical nephrectomy in the setting of a renal artery aneurysm

Abstract

Objective: Renal artery aneurysms (RAA) may pose significant surgical challenges when encountered with coexisting pathology such as renal tumors. Herein, we demonstrate the management of a patient with an enhancing 6.6 cm central right renal mass and an ipsilateral 2.0 cm RAA. We present the technique for robotic transabdominal right radical nephrectomy in the setting of a right RAA. Surgical Procedure: The patient was placed in the left lateral decubitus position. The ascending colon was mobilized medially to expose the right kidney. The interaortocaval inferior vena cava was exposed. Dissection was performed in a plane inferior to the left renal vein, and the aorta was identified. The right renal artery was skeletonized. A nonabsorbable polymer clip was placed across the right renal artery proximal to the right RAA, followed by a metal clip on either side of the polymer clip. The right renal hilum was dissected. A 60 mm vascular stapler was placed across the right renal vein and right renal artery distal to the right RAA. A nonabsorbable polymer clip was placed across the distal ureter which was then transected proximally. The kidney was completely freed from remaining attachments and was placed into a bag for extraction. Results: The patient had an uncomplicated post-operative course. Pathology revealed pT1bN0 chromophobe renal cell carcinoma with negative surgical margins. 2 years postoperatively, imaging continues to show no evidence of local tumor recurrence or metastatic disease. The RAA has diminished in size over time. Conclusions: Achieving proximal control of the renal artery is paramount when performing radical nephrectomy in the setting of RAA. Robotic surgery remains a viable option in the minimally invasive management of renal masses with complex vascular considerations.