Robot-assisted laparoscopic partial nephrectomy with hydrodissection

Abstract

Introduction: Nephron-sparing surgery is reporting satisfactory oncological results, with improved quality of life. The laparoscopic approach is technically complex and requires advanced skills; however, the use of robotic systems facilitates the transition to this procedure. With improved strategies for diagnosis and follow-up, as well as ablative technologies, the role of partial nephrectomy continuous to evolve. The use of water-jet technology to dissect and resect organs helps create anatomical planes in a relatively blood-free field, which improves vision and does not cause heat damage.

Material and methods: We present the case of a patient with an incidental diagnosis of a complex right renal cyst managed with robot-assisted laparoscopic partial nephrectomy using hydrodissection for tumour resection.

Results: The surgery was performed with 2 robotic arms. Four ports were routinely placed, the colon was mobilised, and the tumour was dissected. Tumour delimitation was performed with laparoscopic ultrasound, and the renal artery was clamped. We then performed the tumour resection assisted by a laparoscopic water-jet applicator, operated by the assistant through an auxiliary port. The renal parenchyma was reconstructed in 2 planes, without knots, and the arterial clamp was withdrawn at 23minutes. The resection margins were negative.

Conclusions: The use of water-jet technology to assist with the renal tumour resection during minimally invasive nephron-sparing surgery facilitates the dissection, making it more fluid and atraumatic. Simultaneously, the technique provides a clean surgical field, which improves visibility. This procedure can help decrease ischaemia times, thereby positively affecting the patient's evolution without compromising the oncological results.

Keywords: Cirugía conservadora de nefronas; Enucleación de tumor renal; Hidrodisección; Hydrodissection; Nefrectomía parcial laparoscópica robot-asistida; Nephron-sparing surgery; Renal tumour enucleation; Robot-assisted laparoscopic partial nephrectomy.