ROBOT-ASSISTED HEMINEPHRECTOMY USING AN IMAGE-GUIDED ANATOMICAL TUMOR DEVASCULARIZATION TECHNIQUE

You have accessJournal of UrologyRenal Oncology I1 Apr 2018V07-01 ROBOT-ASSISTED HEMINEPHRECTOMY USING AN IMAGE-GUIDED ANATOMICAL TUMOR DEVASCULARIZATION TECHNIQUE Astrid de Hauteclocque, Souleymane Maiga, Clément Michiels, Clément Allenet, Thibault Marquette, Grégoire Capon, Grégoire Robert, Henri Bensadoun, Nicolas Grenier, Jean-Marie Ferrière, and Jean-Christophe Bernhard Astrid de HauteclocqueAstrid de Hauteclocque More articles by this author , Souleymane MaigaSouleymane Maiga More articles by this author , Clément MichielsClément Michiels More articles by this author , Clément AllenetClément Allenet More articles by this author , Thibault MarquetteThibault Marquette More articles by this author , Grégoire CaponGrégoire Capon More articles by this author , Grégoire RobertGrégoire Robert More articles by this author , Henri BensadounHenri Bensadoun More articles by this author , Nicolas GrenierNicolas Grenier More articles by this author , Jean-Marie FerrièreJean-Marie Ferrière More articles by this author , and Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1760AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conservative management of high volume kidney tumors has several goals : optimal sparing of healthy parenchyma, free margin tumoral excision and avoidance of extended ischemia. The objective of this video was to illustrate the image-guided anatomical tumor devascularization technique through an heminephrectomy case. METHODS Synapse 3D Software (Fujifilm) was used for pre-operative CT Scan segmentation. The resulting 3D-model of the kidney displaying the vascular and collecting system anatomy allowed the selection of third and forth-order clamping spots with prediction of the related parenchymal ischemia. The surgery was performed with the Da-Vinci surgical robot (Intuitive Surgical) and intra-operative assistance for image-guidance comprised 3D model and ultrasound, both relayed on the console screen. Clinical data were collected in the French kidney cancer prospective database UroCCR after patient consent. RESULTS The patient, a 41 year-old male, BMI 38, presented with a 8cm hilar tumor on the upper and mid-pole of the right kidney. It was rated as a highly complex tumor regarding RENAL (10ph) and PADUA (13p). Pre-operative screening of third and fourth-order tumor-feeding arterial branches permitted to plan the devascularization of the tumor with a minor effect on the healthy parenchyma. The tumor limits were compared with the pattern of ischemia using an intra-operative doppler ultrasound. Once all tumor-feeding arteries were clipped, an off-clamp minimal margin tumor excision was performed. The length of surgery was 240 minutes and blood loss was 150ml. Pathologic examination confirmed a Fuhrman grade 4 clear-cell renal carcinoma, stage pT3a with negative surgical margin. The patient was discharged on post-operative day one without any complication. Based on post-operative month 3 CT-scan, the volume of spared parenchyma was 95ml and 82% of tumor-free parenchymal volume (115ml). The CT-scan showed a harmonious enhancement of the spare kidney. CONCLUSIONS The anatomical tumor devascularization technique for high-volume tumors combines safe tumor removal with minimal ischemia. Intra-operative image-guidance with endoscopic US and 3D model make the surgery achievable. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e741 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Astrid de Hauteclocque More articles by this author Souleymane Maiga More articles by this author Clément Michiels More articles by this author Clément Allenet More articles by this author Thibault Marquette More articles by this author Grégoire Capon More articles by this author Grégoire Robert More articles by this author Henri Bensadoun More articles by this author Nicolas Grenier More articles by this author Jean-Marie Ferrière More articles by this author Jean-Christophe Bernhard More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...