Single-Port Robot-Assisted Laparoscopic Right Off-Clamp Partial Nephrectomy
Angela Estevez, MD, Utsav Bansal, MD, Philip Kim, MD, Andrew A Wagner, MD, Peter Chang, MD, MPH
Beth Israel Deaconess Medical Center, Boston, MA, USA
Introduction: We present the case of a 54 year-old male with a Bosniak 4 cyst of the right kidney measuring 3.6 cm on MRI. The patient was referred to our institution to discuss further management and we performed a single-port robotic assisted laparoscopic right partial nephrectomy off-clamp. Methods: The patient was placed in a right side-up modified lateral decubitus position and a 3cm incision made along McBurney’s point. An additional 12 mm Airseal port was placed infraumbilically along the midline as an assistant port. We began by mobilizing the colon medially and subsequently developed a space posterolateral to the kidney, lifting the kidney anteromedially. Afterwards, we dissected through Gerota’s fascia to identify the renal mass and used intraoperative ultrasound to delineate the boundaries. The mass was excised off clamp and a 3-0 V-loc suture was used to oversow the base of the resection bed. 0-Vicryl sutures were then used to reapproximate the parenchyma using a sliding clip renorrhaphy technique.Results: The operative time was 214 minutes with an estimated blood loss of 750 cc. There were no intraoperative complications. The patient tolerated the procedure well and was discharged post-operative day one. The patient was evaluated one month after surgery and was recovering well. Pathology reported low grade clear cell renal cell carcinoma with negative margins. Conclusions: The patient underwent a successful procedure with no complications and showed excellent recovery during the follow-up period.
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