RCC accounts for 2% to 3% of all adult malignant neoplasms. The increasing incidence of asymptomatic low stage tumors detected during routine / unrelated investigations has lead to an increased requirement of nephron sparing surgery. Robot-assisted partial nephrectomy (RPN) has emerged as a preferred technique, with excellent short-term cancer and functional outcomes and decreased morbidity in selected patients. Herein, we describe our technique of robot-assisted clamp less partial nephrectomy.
We report here a case of 64-year-old male, a known case of hypertension and chronic kidney disease, who was incidentally detected to have right renal mass. MRI abdomen revealed a well-defined solid cystic lesion measuring 3.3×3.2×3.6 cm in upper pole cortex of right kidney with peri-nephric stranding and normal renal vein and IVC, and bilateral renal simple cortical cysts. The serum creatinine was 2.4 mg% and the patient was not dependent on dialysis. Clamping the renal pedicle could result in ischemic damage to the nephrons, thereby tilting the balance, making the patient dialysis dependent.
Patient underwent Robot assisted Clamp less Partial Nephrectomy. He tolerated the procedure well with stable preserved postoperative renal functions, and hemogram. Drain was removed on 3rd postoperative day and patient discharged subsequent day. HPE of the renal mass specimen was turned out to be papillary cell carcinoma (Type I), with Fuhrman nuclear grade 2.The tumor was well defined and renal parenchymal excision margin was >1 mm away. Serum creatinine one year after the procedure is 2.1 mg%.
Robot Assisted Clamp Less Partial Nephrectomy is supposed to cause less insult to the nephrons as this represents a truly ‘zero ischemia’ condition. This may be contemplated in selected favorable cases.