Robotic Partial Nephrectomy

Abstract

OBJECTIVE: Partial nephrectomy remains a technically challenging procedure when performed in a minimally invasive manner. In this video we present the operative technique for robotic left partial nephrectomy (RPN). METHODS: A 5 cm interpolar left kidney mass was discovered incidentally in a 57 year old woman. Notably the patient had a history of polio with multiple operations on upper and lower extremities. Metastatic evaluation was otherwise negative. After placing the patient in modified flank position, a 3 arm robotic approach with 2 assistant ports was performed. After mobilization of the colon, the ureter was dissected and followed proximally until the hilum was identified. Two renal arteries and one renal vein were circumferentially dissected and the entire kidney was mobilized within Gerota's fascia. A benign parenchymal margin was marked with cautery and the renal vessels were seperately controlled with laparoscopic bulldog clamps. The tumor was excised using cold scissors and base of the resection bed was oversewn with a 2/0 vicryl running suture. A bolsterless capsular renorrhaphy was performed using a continuous horizontal matress technique with 0 vicryl. Hemostasis was ensured and closed suction drain was inserted. RESULTS: The operative time was 240 minutes and warm ischemia time was 32 minutes. Intraoperative blood loss was 150 cc without complications. The drain was removed after confirming the fluid creatinine was consistent with serum on postoperative day 3. CONCLUSIONS: The robotic approach provides the dexterity and instinctive maneuverability to perform an efficient minimally invasive partial nephrectomy.