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Tips and Tricks for Excision of Renal Tumours

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Robotic Urologic Surgery

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Abstract

Partial nephrectomy is considered the standard of care for T1a and appropriate T1b tumours. Robotic partial nephrectomy has become cornerstone of treatment for simple tumours and has proven to be oncologically safe and functionally effective. It is routinely practised for tumours of low complexity, but endophytic, hilar, multifocal and complex cystic tumours can be a barrier for many surgeons. As surgeon experience has matured, the evidence has shown that the robotic approach is feasible for these challenging cases. Meticulous preparation, judicious use of imaging technology and patient selection are paramount in managing complex cases. To this end, urologists have embraced a variety of technical and imaging innovations including the use of indocyanine green dye with near-infrared fluorescent imaging, intracorporeal ultrasound with TilePro™ and 3D reconstruction of tumour and renal anatomy for better results.

In this chapter we elaborate on techniques for surgeons to consider when excising renal endophytic, cystic, hilar and multiple renal tumours. Excision should aim to achieve a fine balance between preserving renal parenchyma, maintaining negative surgical margins, keeping low warm ischaemia time and minimising the risk of intraoperative complications.

We list various precautions, techniques and surgical steps to enable favourable outcomes and ensure that a minimally invasive approach can be offered to patients with complex renal tumours.

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References

  1. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.

    Article  PubMed  Google Scholar 

  2. White MA, Haber G-P, Autorino R, Khanna R, Hernandez AV, Forest S, et al. Outcomes of robotic partial nephrectomy for renal masses with nephrometry score of ≥7. Urology. 2011;77(4):809–13.

    Article  PubMed  Google Scholar 

  3. Long J-A, Yakoubi R, Lee B, Guillotreau J, Autorino R, Laydner H, et al. Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes. Eur Urol. 2012;61(6):1257–62.

    Article  PubMed  Google Scholar 

  4. Kim DK, Komninos C, Kim L, Rha KH. Robot-assisted partial nephrectomy for endophytic tumors. Curr Urol Rep. 2015;16(11):76.

    Article  PubMed  Google Scholar 

  5. Furukawa J, Miyake H, Tanaka K, Sugimoto M, Fujisawa M. Console-integrated real-time three-dimensional image overlay navigation for robot-assisted partial nephrectomy with selective arterial clamping: early single-centre experience with 17 cases: Real-time 3D image navigation for robot-assisted partial nephrectomy. Int J Med Robot. 2014;10(4):385–90.

    Article  PubMed  Google Scholar 

  6. Hughes-Hallett A, Pratt P, Mayer E, Martin S, Darzi A, Vale J. Image guidance for all – TilePro display of 3-dimensionally reconstructed images in robotic partial nephrectomy. Urology 2014;84(1):237–242.

    Google Scholar 

  7. Porpiglia F, Checcucci E, Amparore D, Piramide F, Volpi G, Granato S, et al. Three-dimensional augmented reality robot-assisted partial nephrectomy in case of complex tumours (PADUA ≥10): a new intraoperative tool overcoming the ultrasound guidance. Eur Urol. 2020;78(2):229–38.

    Article  PubMed  Google Scholar 

  8. Tobis S, Knopf JK, Silvers C, Messing E, Yao J, Rashid H, et al. Robot-assisted and laparoscopic partial nephrectomy with near infrared fluorescence imaging. J Endourol. 2012;26(7):797–802.

    Article  PubMed  Google Scholar 

  9. Hekman MCH, Rijpkema M, Langenhuijsen JF, Boerman OC, Oosterwijk E, Mulders PFA. Intraoperative imaging techniques to support complete tumor resection in partial nephrectomy. Eur Urol Focus. 2018;4(6):960–8.

    Article  PubMed  Google Scholar 

  10. Bjurlin MA, Gan M, McClintock TR, Volpe A, Borofsky MS, Mottrie A, et al. Near-infrared fluorescence imaging: emerging applications in robotic upper urinary tract surgery. Eur Urol. 2014;65(4):793–801.

    Article  PubMed  Google Scholar 

  11. Minervini A, Carini M. Tumor enucleation is appropriate during partial nephrectomy. Eur Urol Focus. 2019;5(6):923–4.

    Article  PubMed  Google Scholar 

  12. Minervini A, Campi R, Di Maida F, Mari A, Montagnani I, Tellini R, et al. Tumor-parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma. Urol Oncol. 2018;36(12):527.e1–527.e11.

    Article  PubMed  Google Scholar 

  13. Minervini A, Campi R, Sessa F, Derweesh I, Kaouk JH, Mari A, et al. Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors: systematic review of the literature and meta-analysis of prevalence. Minerva Urol Nefrol. 2017;69(6):523–38.

    PubMed  Google Scholar 

  14. Borofsky MS, Gill IS, Hemal AK, Marien TP, Jayaratna I, Krane LS, et al. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy: Near-infrared fluorescence imaging in zero ischaemia RPN. BJU Int. 2013;111(4):604–10.

    Article  PubMed  Google Scholar 

  15. Feliciano J, Stifelman M. Robotic retroperitoneal partial nephrectomy: a four-arm approach. JSLS. 2012;16(2):208–11.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dulabon LM, Kaouk JH, Haber G-P, Berkman DS, Rogers CG, Petros F, et al. Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol. 2011;59(3):325–30.

    Article  PubMed  Google Scholar 

  17. Arora S, Rogers C. Partial nephrectomy in central renal tumors. J Endourol. 2018;32(S1):S63–7.

    Article  PubMed  Google Scholar 

  18. Khalifeh A, Autorino R, Hillyer SP, Kaouk JH. V-hilar suture renorrhaphy during robotic partial nephrectomy for renal hilar tumors: preliminary outcomes of a novel surgical technique. Urology. 2012;80(2):466–71.

    Article  PubMed  Google Scholar 

  19. Spaliviero M, Herts BR, Magi-Galluzzi C, Xu M, Desai MM, Kaouk JH, et al. Laparoscopic partial nephrectomy for cystic masses. J Urol. 2005;174(2):614–9.

    Article  PubMed  Google Scholar 

  20. Bielsa O, Lloreta J, Gelabert-Mas A. Cystic renal cell carcinoma: pathological features, survival and implications for treatment. Br J Urol. 1998;82(1):16–20.

    Article  CAS  PubMed  Google Scholar 

  21. Pinheiro T, Sepulveda F, Natalin RH, Metrebian E, Medina R, Goldman SM, et al. Is it safe and effective to treat complex renal cysts by the laparoscopic approach? J Endourol. 2011;25(3):471–6.

    Article  PubMed  Google Scholar 

  22. Akca O, Zargar H, Autorino R, Brandao LF, Laydner H, Kaouk JH, et al. Robotic partial nephrectomy for cystic renal masses: a comparative analysis of a matched-paired cohort. Urology. 2014;84(1):93–8.

    Article  PubMed  Google Scholar 

  23. Nassir A, Jollimore J, Gupta R, Bell D, Norman R. Multilocular cystic renal cell carcinoma: a series of 12 cases and review of the literature. Urology. 2002;60(3):421–7.

    Article  PubMed  Google Scholar 

  24. You D, Shim M, Jeong IG, Song C, Kim JK, Ro JY, et al. Multilocular cystic renal cell carcinoma: clinicopathological features and preoperative prediction using multiphase computed tomography: multilocular cystic renal cell carcinoma. BJU Int. 2011;108(9):1444–9.

    Article  PubMed  Google Scholar 

  25. Aubert S, Zini L, Delomez J, Biserte J, Lemaitre L, Leroy X. Cystic renal cell carcinomas in adults. Is preoperative recognition of multilocular cystic renal cell carcinoma possible? J Urol. 2005;174(6):2115–9.

    Article  PubMed  Google Scholar 

  26. Novara G, La Falce S, Abaza R, Adshead J, Ahlawat R, Buffi NM, et al. Robot-assisted partial nephrectomy in cystic tumours: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. BJU Int. 2016;117(4):642–7.

    Article  PubMed  Google Scholar 

  27. Chen S-Z, Wu Y-P, Chen S-H, Li X-D, Sun X-L, Huang J-B, et al. Risk factors for intraoperative cyst rupture in partial nephrectomy for cystic renal masses. Asian J Surg. 2021;44(1):80–6.

    Article  PubMed  Google Scholar 

  28. Simmons MN, Hillyer SP, Lee BH, Fergany AF, Kaouk J, Campbell SC. Functional recovery after partial nephrectomy: effects of volume loss and ischemic injury. J Urol. 2012;187(5):1667–73.

    Article  PubMed  Google Scholar 

  29. Mir MC, Campbell RA, Sharma N, Remer EM, Simmons MN, Li J, et al. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology. 2013;82(2):263–8.

    Article  PubMed  Google Scholar 

  30. Baltaci S, Orhan D, Soyupek S, Bedük Y, Tulunay O, Gögüs O. Influence of tumor stage, size, grade, vascular involvement, histological cell type and histological pattern on multifocality of renal cell carcinoma. J Urol. 2000;164(1):36–9.

    Article  CAS  PubMed  Google Scholar 

  31. Herring JC, Enquist EG, Chernoff A, Linehan WM, Choyke PL, Walther MM. Parenchymal sparing surgery in patients with hereditary renal cell carcinoma: 10-year experience. J Urol. 2001;165(3):777–81.

    Article  CAS  PubMed  Google Scholar 

  32. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C-Y. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.

    Article  CAS  PubMed  Google Scholar 

  33. Boris R, Proano M, Linehan WM, Pinto PA, Bratslavsky G. Initial experience with robot assisted partial nephrectomy for multiple renal masses. J Urol. 2009;182(4):1280–6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Johnson A, Sudarshan S, Liu J, Linehan WM, Pinto PA, Bratslavsky G. Feasibility and outcomes of repeat partial nephrectomy. J Urol. 2008;180(1):89–93.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Bratslavsky G, Liu JJ, Johnson AD, Sudarshan S, Choyke PL, Linehan WM, et al. Salvage partial nephrectomy for hereditary renal cancer: feasibility and outcomes. J Urol. 2008;179(1):67–70.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. St. Georges University Hospital, London, UK

    C. J. Anderson & D. Aggarwal

  2. Onze Lieve Vrouw Hospital, Aalst, Belgium

    A. Mottrie

  3. ORSI Academy, Melle, Belgium

    A. Mottrie

  4. Pitie-salpetriere Academic Hospital, Assistance publique-hopitaux de Paris, Sorbonne Universite, Paris, France

    C. Vaessen

Authors
  1. C. J. Anderson
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  2. D. Aggarwal
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  3. A. Mottrie
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  4. C. Vaessen
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Editor information

Editors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA

    Peter Wiklund

  2. Department of Urology, ORSI Academy, Aalst, Belgium

    Alexandre Mottrie

  3. Pediatric Urology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Mohan S Gundeti

  4. Urology, Global Robotics Institute, Celebration, FL, USA

    Vipul Patel

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Anderson, C.J., Aggarwal, D., Mottrie, A., Vaessen, C. (2022). Tips and Tricks for Excision of Renal Tumours. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_40

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  • DOI: https://doi.org/10.1007/978-3-031-00363-9_40

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-00362-2

  • Online ISBN: 978-3-031-00363-9

  • eBook Packages: MedicineMedicine (R0)

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