“Zero Ischemia” Robotic Partial Nephrectomy

Abstract

The video shows two cases of "Zero Ischemia" robotic partial nephrectomy.
The former is a case of a 4.3cm left renal tumor with predominant endophytic growth. With patient in extended flank position, a 5-trocar access was performed. The renal capsule was opened and the tumor isolated. Tumor margins were scored and dissection plane was prepared with scissors. The initial dissection was performed and bleeding control was achieved by using monopolar coagulation. During the deep dissection, Pneumoperitoneum was raised to 20mmHg and controlled hypotension was obtained. Bleeding control was achieved by combining selective clip ligation of small tumor feeders and monopolar coagulation. A suture was performed to complete hemostasis and to reconstruct the renal parenchyma.
The second one is a case of a totally endophytic 3.5cm right renal tumor. After the incision, a rim of healthy parenchyma surrounding the tumor was progressively dissected in order to develop the tumor pseudo-capsule. A blunt dissection combining monopolar coagulation and superselective clip ligation of small feeding arteries was performed to develop the enucleation plane. The Haemostatic closure of renal parenchyma defect was performed through a running suture with an end secured with a Lapra-TY. A drain was left in place.