Enucleation technique for robotic partial nephrectomy

Abstract

Objective: To report our technique of robotic enucleation for the management of renal masses focusing of preoperative considerations and intraoperative nuances. Patients and surgical procedure: In our center, all patients with suspicious renal mass amenable to partial nephrectomy and presenting an identifiable tumor pseudocapsule are submitted to robotic pure enucleation. Several steps have to be followed to perform a successful tumor enucleation. In particular, 1) preoperative evaluation of the tumor and renal anatomical complexity; 2) accurate intraoperative identification of the tumor margins; 3) reaching the tumor pseudocapsule through an anatomic resection strategy; 4) adapting the ischemia management in order to maintain a bloodless surgical field; 5) enucleative resection technique 6)minimizing tumor tensions; 7) anatomical renorraphy. Results: Pure enucleation is effectively performed. Conclusions: Tumor enucleation represents the most anatomical technique for partial nephrectomy since it maximizes the amount of healthy renal parenchyma spared. Evidence supports the adoption un pure enucleation whenever feasible.

Keywords

• Oncology
• Pure enucleation
• Renal cell carcinoma
• Robotics