Tumor enucleoresection in robot-assisted partial nephrectomy

Abstract

The objective of this study is to describe our technique and results of the enucleoresection technique in robot-assisted partial nephrectomy. The patient is positioned in full flank position. Three robotic arms of a da Vinci system and an assistant's port are used. The renal hilus is freed, the kidney mobilized and the site of the partial excision prepared. The vessels are clamped with a bulldog. The capsula of the kidney is incised circular about 5 mm around the tumor. A pseudocapsula of compressed healthy tissue around the tumor is found and mainly blunt dissection is done with the cold scissors. At the base of the dissection, the resection is completed sharply. Possible calyceal defects and major vessels are stitched. Fibrinogen coagulation enhancer and cellulose coagulation sponge are used to lessen the gap and the renal defect is closed with absorbable suture. The kidney is re-perfused and observed for bleeding. We have performed 17 cases with warm ischemia time 16-35 min (mean 24 min) and tumor size 2.2-5.3 cm (mean 3.8 cm). All surgical margins were tumor free. No postoperative complications were identified except one clot retention. Robot-assisted enucleoresection of kidney tumors is a feasible and very promising technique that needs to be further evaluated for results.

Strategies for success: a multi‐institutional study on robot‐assisted partial nephrectomy for complex renal lesions

“…The PK forceps were used to manipulate the tumour away from normal parenchyma to aid dissection. While enucleation and enucleoresection techniques are described and associated with excellent outcomes , it is the preference of the authors to excise the tumour with a clear margin of normal parenchyma. This stage required deft ‘duck and weave’ movements of the surgical assistant with suction, to maintain visualization of the resection plane (Fig.…”

Robotic partial nephrectomy: The new horizon

“…The overlying perinephric fat and a small margin of normal renal parenchyma are resected en bloc with the tumour. Mottrie et al [31] were the first to describe a robotic tumour enucleoresection technique, identifying a plane 0.5 cm away of the tumour and dissecting almost exclusively bluntly. Later, Boris et al [32] also reported a RPN enucleating technique for hereditary multiple tumours.…”

Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review

“…Finally, 20 studies met the inclusion criteria and were included in the analysis. Of these, five were single-arm studies [12] , [13] , [14] , [15] , [16] and 15 were comparative studies [5] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] . Review of the quality assessment and level of evidence revealed a moderate to high risk of bias overall, and a moderate to very low level of evidence ( Supplementary Fig.…”

“…Five studies analyzed the impact of the resection technique used on outcomes of interest. Mottrie et al [12] reported on a series of 17 patients who underwent robot-assisted enucleoresection. The authors underlined that owing to compression of the tumor on the normal renal parenchyma, a pseudocapsule of healthy parenchyma a few millimeters away from the tumor usually offered a safe plane for blunt dissection.…”