Robotic And Laparoscopic Partial Nephrectomy Without Vascular Clamping And Renal Ischemia

June 17, 2010

Objective: Robotic and laparoscopic partial nephrectomy is a treatment option for small renal masses (less than 4cm). During the procedure, clamping of the renal vessels is required to minimize bleeding. This video presents a technique utilizing hemostatic hydrodissection and bipolar and radio frequency coagulation to avoid renal vascular clamping and renal ischemia.

Methods: Review of 22 cases from January 2006 to October 2007. Fourteen patients underwent hemostatic hydrodissection (Helix HydroJet), bipolar coagulation (Erbe BiClamp Coagulator), and radio frequency coagulation of the margin (RITA Habib RFA probe). Renal hilum was dissected in all cases so that renal vascular clamping could be performed if bleeding was encountered. Postoperative follow-up ranged from 1 month to 21 months.

Results: None of the 14 cases required vascular clamping. Mean patient age was 61 years (range, 37 to 70), mean renal mass size was 2.6cm (range, 1.1 to 3.7), mean estimated blood loss was 162cc (range, 20 to 500), and mean operative time was 198 minutes (range, 120 to 300). All resection margins were negative for malignancy. One patient had a horseshoe kidney. Eight patients had the transperitoneal approach, and 6 had the retroperitoneal approach. Mean hospital duration of stay was 4 days (range, 2 to 6). Two delayed urine leaks occurred that were treated conservatively. All patients had no significant change from baseline serum creatinine. Final pathology was as follows: 6 renal cell carcinomas, 2 angiomylipomas, 1 oncocytoma, and 5 complex hemorrhagic cysts.

Conclusions: This new technique for robotic and laparoscopic partial nephrectomy appears to be a safe technique that avoids renal vascular clamping and renal ischemia. Further testing and follow-up will determine longer-term outcomes.

Authors: Carl Bischoff, Miranda J. Hardee, Benjamin K. Canales, Chester B. Algood, Charles J. Rosser, Philipp Dahm, Johannes W. Vieweg, Sijo J. Parekattil