Robot-assisted partial nephrectomy for new or recurrent tumor in patient with prior partial nephrectomy or tumor ablation

You have accessJournal of UrologyCME1 Apr 2023V05-09 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR NEW OR RECURRENT TUMOR IN PATIENT WITH PRIOR PARTIAL NEPHRECTOMY OR TUMOR ABLATION Sumit Saini, Timothy O'Rourke, Parth Thakker, and Ashok Hemal Sumit SainiSumit Saini More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , Parth ThakkerParth Thakker More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage robot-assisted partial nephrectomy (sRAPN) for new or recurrent renal tumor is a technically challenging procedure secondary to varying degree of peri & paranephric fibrosis and intrarenal changes in parenchymal architecture. Here in, we demonstrate surgical technique in such complex cases. METHODS: Between January 2013 and July 2022, we queried our prospectively maintained institutional database. We identified 20 renal lesions in 18 patients who underwent robot-assisted salvage partial nephrectomy for local recurrences after prior partial nephrectomy or tumor ablation. Meticulous dissection through the adhesions while ensuring a rim of normal renal parenchyma is the key to achieve negative surgical margins in these challenging cases. Intraoperative ultrasound and indocyanine green-near infrared fluorescence imaging (ICG-NIRF) also play an indispensable role in these cases. RESULTS: Majority of our patients either had prior cryoablation or prior partial nephrectomy (Table 1). A second/new renal lesion was noted in 2 patients in the same kidney following initial cryoablation which were also excised simultaneously. Median time to recurrence from primary procedure was 2 years (1-7) and mean age at salvage surgery was 65±10.2 years. Mean operative time was 161.4 minutes (66-348) and mean warm ischemia time was 23.3±4.6 minutes. All the surgical margins were negative and none of the patients developed any major complications post-operatively. At median follow up of 15 months (3-62), all patients are alive and none of the patients developed any recurrence. CONCLUSIONS: sRAPN for new or recurrent renal tumor in patients with prior partial nephrectomy or tumor ablation is technically feasible with excellent peri-operative and oncological outcomes. However, it requires prudent cross-sectional imaging to understand spatial anatomy and technical tools such as intraoperative ultrasound/near infrared fluorescence imaging with ICG. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit Saini More articles by this author Timothy O'Rourke More articles by this author Parth Thakker More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...