Introduction. Nephron-sparing surgery is the current gold standard for the surgical treatment of localized renal cell carcinoma (RCC). Partial nephrectomy can be performed by off-clamp or on clamp techniques. It is especially important to preserve renal function during partial nephrectomy in comorbid patients. Objective. To evaluate the perioperative results of robot-assisted partial nephrectomy with zero ischemia in comorbid patients with RCC. Materials and Methods. At the Almazov Center we retrospectively studied the results of 11 comorbid patients who underwent robot-assisted partial nephrectomy with zero ischemia from 2019 to 2022. In 3 (27.3%) of them, renal mass was detected in a solitary kidney. In preoperative period 3D reconstruction was performed using the 3D Slicer modeling program. For rapid mobilization of the renal vessels we used «method of safe exposure of renal pedicle vessels during endovideosurgical resection of the kidney and radical nephrectomy during laparoscopic and robot-assisted operations» (patent RU 2742367). The boundaries of resection were determined with an intracavitary ultrasound probe BK Flex Focus 800. Renal function was assessed by glomerular filtration rate (GFR) using the Chronic Kidney Desease Epidemiology Collaboration (CKD-EPI) formula. Results. There were no intraoperative and postoperative complications. The median console operation time was 110 min [58–130]. Median estimate blood loss was 100 ml [50-280]. No cases had a positive surgical margin. In the postoperative period, GFR was comparable to preoperative values. Conclusion. Robot-assisted partial nephrectomy with zero ischemia for comorbid patients is more expedient to be performed in a multidisciplinary center of competence. The effectiveness of perioperative results of robot-assisted partial nephrectomy with zero ischemia is achieved by using highly informative diagnostic imaging methods and performing a safe method of isolating renal vessels during the operation with rapid renorrhaphy performed by an experienced surgeon.

The combination of renal cell carcinoma and urolithiasis in the same kidney is rare. The management of patients who have two such diseases simultaneously is primarily determined by renal cell carcinoma as the dominant disease. To date, modern diagnostic and surgical technologies make it possible to perform partial nephrectomy with simultaneous removal of a calculus from the pelvicalyceal system using minimally invasive endovideosurgical methods. This study aimed to demonstrate the possibility of performing robot-assisted nephrectomy with calicolithotomy in a patient with abnormalities of renal vessels. This work presents a clinical case of a 36-year-old man hospitalized with a neoplasm of the right kidney measuring 38 35 35 mm, detected during multislice computed tomography. In the lower group of calices of the kidney, a 5 4 mm calculus with a density of 1200 HU was found. The presence of anomalies of the renal vessels served as the basis for a three-dimensional (3D) reconstruction of the right kidney using the 3D Slicer modeling program. The patient underwent a robot-assisted kidney resection with calicolithotomy on a da Vinci SI robot. Intraoperatively, an ultrasound examination of the kidney was performed using an intracavitary sensor BK Flex Focus 800. The console operating time of the operating surgeon was 110 min. Blood loss was approximately 100 ml. The warm ischemia time was 20 min. The postoperative period proceeded without complications. At 3 weeks postoperatively, nephrogenic arterial hypertension disappeared. Laboratory studies conducted 3 months after surgery indicated an increase in the glomerular filtration rate compared with preoperative results. 3D reconstruction allows rational planning of the scope of surgical intervention during preoperative preparation. Kidney resection with calicolithotomy is optimally performed using the da Vinci robot, which allows complex surgical techniques to be performed using endovideosurgical methods.