Slideshow
-
Slide 1
Computed tomography scans demonstrate a 2.5 cm left hilar renal mass posterior to the left renal artery with a R.E.N.A.L. nephrometry score of 1+2+3+p+3h=9ph
-
Slide 2
Computed tomography scans demonstrate a 2.5 cm left hilar renal mass posterior to the left renal artery with a R.E.N.A.L. nephrometry score of 1+2+3+p+3h=9ph
A 45-year-old man is incidentally found to have a 2.5 cm left hilar renal mass posterior to the left renal artery with a R.E.N.A.L. nephrometry score of 1+2+3+p+3h=9ph. The patient’s estimated glomerular filtration rate is 50 mL/min/1.72m2.
Submit your diagnosis to see full explanation.
Although a transperitoneal partial nephrectomy is feasible, the retroperitoneal robotic approach is a terrific option for this young patient with renal insufficiency. Access to the kidney is gained posteriorly without entering the peritoneum and avoiding the need to mobilize the kidney (Figure 1). The approach allows ideal access to posterior masses and can also avoid risks of peritoneal dissection in patients with a hostile abdominal cavity. The approach is now gaining traction at many Kidney Cancer Centers of Excellence.1
Figure 1: Usual arrangement of ports for a retroperitoneal robotic partial nephrectomy at the Fox Chase Cancer Center. Set up for a patient with a right-sided tumor is shown.
Case prepared by Alexander Kutikov, MD, FACS, Associate Professor of Urologic Oncology, Fox Chase Cancer Center, Philadelphia (Http://www.fccc.edu/physicians/team/surgical/kutikov.html).
REFERENCE
1. Hu JC, Treat E, Filson CP, et al. Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: A multicenter study. Eur Urol 2014;66:542-549).
QUESTION
