AUA 2018: Robotic Partial Nephrectomy Surgical Techniques

San Francisco, CA USA (UroToday.com) Dr. Desai of the University of Southern California moderated a panel consisting of Dr. Bratslavsky from SUNY Upstate Medical University, Dr. Porter from Swedish Medical Center, and Dr. Herrell from Vanderbilt University Medical Center.

The agenda for the talk was as follows: Dr. Bratslavsky to demonstrate the standard transperitoneal robotic-assisted laparoscopic partial nephrectomy (RPN); Dr. Herrell to demonstrate the transperitoneal RPN for a hilar tumor; and Dr. Porter to demonstrate the setup and access for a retroperitoneal RPN.

Dr. Bratslavsky presented a case of a 77 year-old male presenting with a right renal mass on computed tomography (CT) imaging. The patient had a history of atrial fibrillation (currently on Coumadin), hypertension, and coronary artery disease. On CT, there was a 6.2 cm cystic lesion with an enhancing nodule and a nephrometry score of 8. Final pathology of the mass revealed a 7.0x6.2x5.0 cm, grade III, unclassified renal cell carcinoma with negative margins.

Dr. Herrell emphasized the importance of pre-operative preparation including case selection, imaging evaluation, and consent for possible open and/or radical nephrectomy. For imaging, Dr. Herrell suggested the use of thin cut CT renal angiograms with or without 3D reconstruction, and magnetic resonance imaging with or without gadolinium to differentiate depth.

Dr. Porter covered key aspects of obtaining retroperitoneal access for upper tract robotic surgery including: patient positioning, creating space, port configuration, docking, and fat management. Dr. Porter advocated for the use of the Da Vinci Xi (vs. the Da Vinci Si) as it has four narrower arms, has closer ports, and allows for side docking.

Dr. Desai concluded the talk with a case discussion on the importance of vascular control. He went over the role of pre-operative imaging, as well as intraoperative visualization. He stressed the need to perform a complete hilar dissection and to inspect both the renal vein and the renal cortex. He also discussed options for intraoperative imaging including Doppler and near-infrared fluorescence.

Moderator(s): Mihir Desai

Panelist(s): Gennady Bratslavsky, James Porter, and Duke Herrell, III

Written by: Michael Owyong, MD, Twitter: @ohyoungmike, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA