Robotic Partial Nephrectomy in the Setting of Renal Insufficiency: Techniques to Minimize Warm Ischemia Time and Preserve Renal Function

Abstract

Introduction:

We present our experience with robotic partial nephrectomy (RPN) in patients with renal insufficiency and present tips and tricks to minimize warm ischemia time (WIT) and preserve renal function.

Materials and Methods (including a description of the video):

Twenty consecutive patients with preexisting renal insufficiency [estimated glomerular filtration rate (eGFR) <60 mL/min] undergoing RPN comprised our study cohort. eGFR was calculated using the Modification of Diet in Renal Disease equation. ¹ Patients underwent off clamp resection, intracorporeal hypothermia, enucleoresection, or early unclamping and renorrhaphy with a barbed suture, all with an aim to minimize WIT and maximize renal preservation. Patient demographics and outcomes were evaluated.

Results:

Mean preoperative eGFR was 52 mL/min (standard deviation = 8.7). Mean tumor size was 3.1 cm; mean WIT, 14 min; mean estimated blood loss, 164 mL. Thirteen patients underwent hilar clamping (two with hypothermia), eight with off clamp resection. Two patients had solitary kidney and two patients underwent enucleoresection. Mean postoperative decrease in eGFR was 11% at 1 month and 2.2% at mean follow-up of 6.2 months (1–19.3). There was one positive margin from tumor enucleation in a solitary kidney. There were no recurrences.

Conclusions:

RPN is feasible in the setting of renal insufficiency. Off-clamp resection, enucleoresection, and intracorporeal hypothermia may be considered in these patients to minimize ischemic damage.

All authors have declared no conflicts of interest.

Runtime of video: 6 mins 48 secs