NEFRECTOMÍA PARCIAL ASISTIDA POR DAVINCI EN TRASPLANTE RENAL
Institución:Hospital Son Espases (Palma)
Tipo de presentación:Vídeo
Peraire Lores, M
Bauza Quetglas, JL
Aizpiri Antoñana, L
Vega Vega, C
Amer Mestre, M
Guldris Garcia, R
Tubau Vidaña, V
Martínez Moreno, A
De la Cruz Ruiz, M
Pieras Ayala, E
INTRODUCTION AND OBJECTIVES: The kidney transplant population is supposed to have a two-fold increased risk of developing a malignancy compared to the general healthy population. Even though the incidence of renal cell carcinoma affecting the allograft in transplant recipients is quite rare. Although clinical guidelines for the management of these selected cases are lacking, whenever technically feasible, nephron-sparing surgery is recommended in order to preserve the renal function of these patients. The application of robotic technology can be useful, as complex surgical anatomy could be expected after renal transplantation.
MATERIALS AND METHODS: A 63-year-old female with nephroangiosclerosis nephropathy received a kidney transplant from a deceased donor in 2011. 10 years after transplantation she presented with a 4 cm renal mass (cT1bN0M0) of the allograft incidentally detected on a computerized tomography scan (RENAL score 4 and PADUA score 7). Preoperative serum creatinine was 0.7 mg/dL with an eGFR of 93 mL/min/1.73 m2. A robot-assisted laparoscopic partial nephrectomy was performed through a transperitoneal approach with bulldog clamping of the external iliac artery and maintaining immunosuppression postoperatively.
RESULTS: Operative time including robot’s docking was 190 minutes and warm ischemia time was 18 minutes. Blood losses were negligible, with no transfusions required. Postoperative serum creatinine was 1 mg/dl with an eGFR of 60 mL/min/1.73 m2. There were no intraoperative complications although the patient presented with a bilateral pleural effusion and respiratory failure postoperatively, that prolonged hospital stay until she recovered. Final pathology revealed a 4.5 cm papillary renal cell carcinoma type 1, pT1b, ISUP grade 1. Surgical margins were negative. After 4 months follow-up the patient maintained with an eGFR of 68 mL/min/1.73 m2
CONCLUSION: Robot-assisted laparoscopic partial nephrectomy is technically feasible for renal masses in kidney allografts.
