Urology Video Journal (Sep 2022)
Robotic partial nephrectomy for hilar tumors: The contemporary technique
Abstract
Objective: To describe in a video format the surgical steps and contemporary technique of robotic partial nephrectomy for hilar tumors. Methods: A 37-year-old female patient with a 2.5 cm heterogeneous mass in the left renal hilum was selected for this publication. The surgical steps and techniques of this procedure were recorded. Patients are positioned in a modified flank position at approximately 60 to 75 degrees. Bowel mobilization is performed in the standard fashion. After elevation of the gonadal vein and ureter on the left side and ureter on the right side, dissection continues toward the hilum until we meet the renal vein. The renal artery is identified posterior to the renal vein and is dissected off the surrounding tissue. Gerota's fascia is incised and dissected off the kidney like a clamshell. An intraoperative ultrasound probe is used to identify and mark the margins of the tumor. The renal artery is then clamped. Cold scissors are used to incise renal parenchyma and dissect around the mass. In hilar lesions, vessels feeding the tumor are clipped and divided. Renorrhaphy is performed in 2 layers. Early unclamping is performed after completing the deep renorrhaphy. The tumor is placed in a specimen retrieval bag. Gerota's fascia is reapproximated and the specimen is removed. Results: Partial nephrectomy was completed successfully without any complications. Warm ischemia time was 28 minutes. 90% of kidney volume was preserved. The estimated blood loss was 50 mL. Foley catheter and drain were removed on postoperative days 1 and 2 respectively. The patient was discharged home on postoperative day 2. Final pathology revealed a clear cell renal cell carcinoma, pT3a, with the International Society of Urologic Pathologists (ISUP) grade of 3. Surgical margins were negative. Conclusion: We demonstrated steps and the contemporary technique of the robotic partial nephrectomy for hilar tumors.
