ROBOT-ASSISTED LAPAROSCOPIC SIMPLE ENUCLEATION OF AN INTRAPHARENCHIMAL HILUM ABUTTING RENAL TUMOR

Lorenzo Masieri*, Andrea Minervini, Matteo Salvi, Michele Lanciotti, Chiara Cini, Graziano Vignolini, Giampaolo Siena, Sergio Semi, Alberto Lapni, Marco Carini, Marco Carini, Florence, Italy INTRODUCTION AND OBJECTIVES: We present our surgical technique for Intraparenchymal RCC hilum abutting tumors to show advantages of robot-assisted Simple Tumour Enucleation (TE). METHODS: We show our surgical technique for the treatment of completely intraparenchymal hilum abutting tumor in a 39 years old patient, with incidental diagnosis of 4cm left RCC. A 12mm trocar, two 8mm robotic trocars, a 8mm and a 10mm trocars for the bedside assistant are placed. After Da Vinci© docking, the kidney is completely separated from the perirenal fat to exclude satellite lesions not detected by the imaging technique; the renal pedicle is carefully isolated and the artery is selectively clamped before TE. Then the kidney capsule is sharply incised starting a few millimeters away from the lesion toward the peritumoral capsule; when the pseudocapsule is reached the tumor is enucleated by blunt dissection and scissors using the natural cleav- age piane between the pseudocapsule and nonnal parenchyma. Adopting sliding clips technique, on the bed of resection bleeding vessels and openings in the collecting system are closed using a 3-zero monofilament running sutures. Then the artery is early declamped and the capsular sutures is performed with horizontal interrupted sutures of 2-0 Vicryl filament, apposing hemostatic agents. RE SUL TS: Above ali we performed 108 robotic assisled TE between 2011-2012 for RCC. Operation time: 140min. WIT: 17min. Intraoperalive blood loss: 200cc. Length of hospital stay: 4 Oays Creatinine serum 111 p.o. day: 0,91 mg/dL. Pathologic outcome: Clear Celi RCC Fuhrman G2 3,5x3cm. Negative surgical margins. No evi- dence of tumour diffusion in peritumoral adipose tissues. pT1a pNx pMx CONCLUSIONS: In case of intraparenchymal hilar tumours, thanks to image magnification and endo-wrist © movements, the Da Vinci Surgical System allows to perform TE in a feasible and safe manner.