Imaging and Treatment of Delayed Hemorrhagic Complications of Robotic Assisted Laparoscopic Partial Nephrectomies

Understand the surgical technique of robotic assisted laparoscopic partial nephrectomy (RALPN) with attention to impact on adjacent vascular structures. Review the imaging findings of delayed hemorrhagic complications of RALPN. Understand a proposed imaging and treatment algorithm for patients presenting with delayed hemorrhage. RALPN is becoming an increasingly popular technique for resection of renal masses. Through a retrospective review of cases performed at out institution focused on elucidating the role of CT imaging prior to angiographic management we determined several characteristics of these cases of which an appreciation is imperative for effective interventional management. Between July 2008 and September 2013, 152 RAPNs have been performed at our institution with a delayed hemorrhagic complication incidence of 7.2% and 3.9% requiring embolization of a pseudoaneurysm, multiple pseudoaneurysms or pseudoaneurysm and AVF. Suspected hemorrhagic complications were evaluated with CT imaging which included non-contrast CT (4 cases), single portal venous phase CT (2 cases), multiphase CT (4 cases), and CT angiography (3 cases). Technical aspects of RALPN procedure will be presented. Imaging findings of hemorrhagic complications in our experience will be reviewed. Angiographic findings and endovascular treatment of complications will be reviewed. The RALPN procedure involves techniques different from standard open or laparoscopic partial nephrectomy. Knowledge of these differences and the impact on adjacent blood vessels is important in the management of hemorrhagic complications. A decision-making algorithm for management of these patients will be presented.