Abstract
Clinical History:
This is a case report video of a 73-year-old man. He was referred to our hospital because of macrohematuria and lower back pain.
Physical Exam:
There were no significant findings on physical examination. On CT, a 22 mm tumor was observed in the isthmus of the horseshoe kidney. The tumor was in contact with the right renal calyx, and the isthmus was 30 mm wide and 10 mm thick.
Diagnosis:
The preoperative diagnosis was renal cell carcinoma (RCC), cT1aN0M0. The tumor was located on the right side of the horseshoe kidney.
Intervention:
The operative position was right decubitus. We used four da Vinci instruments. 1 ProGrasp forceps, force bipolar, camera and monopolar curved scissors and three trocars for the assistant were used. To ensure the mobility of the kidney, the isthmus was first dissected. The resection margin was then secured on the left side of the tumor. The off-clamp division of the isthmus was performed using monopolar curved scissors and soft coagulation, as it is difficult to completely block the blood flow to the isthmus. After dividing the isthmus, robot-assisted partial nephrectomy (RAPN) was performed.
Follow-up/Results:
Operative time was 282 minutes. Warm ischemic time was 19 minutes. Estimated blood loss was 50 mL. Serum creatinine level did not worsen postoperatively. Pathology was papillary RCC, pT3a, and resection margin was negative. We have experienced the case where RAPN was safely performed after mobilization of the kidney by off-clamp division of the thick and wide isthmus.
The authors obtained and archived patient consent for video recording/publication in advance of video recording the procedure.
The authors have no conflicts of interest.
Runtime of video: 5 mins 44 secs.
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