Introduction: Salvage robot-assisted partial nephrectomy (sRAPN) for new or recurrent renal tumor is a technically challenging procedure secondary to varying degree of peri & paranephric fibrosis and intrarenal changes in parenchymal architecture. Here in, we demonstrate surgical technique in such complex cases. Methods: Between January 2013 and July 2022, we queried our prospectively maintained institutional database. We identified 20 renal lesions in 18 patients who underwent robot-assisted salvage partial nephrectomy for local recurrences after prior partial nephrectomy or tumor ablation. Meticulous dissection through the adhesions while ensuring a rim of normal renal parenchyma is the key to achieve negative surgical margins in these challenging cases. Intraoperative ultrasound and indocyanine green-near infrared fluorescence imaging (ICG-NIRF) also play an indispensable role in these cases. Results: Majority of our patients either had prior cryoablation or prior partial nephrectomy (Table 1). A second/new renal lesion was noted in 2 patients in the same kidney following initial cryoablation which were also excised simultaneously. Median time to recurrence from primary procedure was 2 years (1-7) and mean age at salvage surgery was 65 +/- 10.2 years. Mean operative time was 161.4 minutes (66-348) and mean warm ischemia time was 23.3 +/- 4.6 minutes. All the surgical margins were negative and none of the patients developed any major complications post-operatively. At median follow up of 15 months (3-62), all patients are alive and none of the patients developed any recurrence. N = 18 Prior Thermal Ablation Modality Cryoablation (Retroperitoneal/Transperitoneal/CT Guided) 10 Radiofrequency Ablation 2 Prior Partial Nephrectomy 6 Conclusions: sRAPN for new or recurrent renal tumor in patients with prior partial nephrectomy or tumor ablation is technically feasible with excellent peri-operative and oncological outcomes. However, it requires prudent cross-sectional imaging to understand spatial anatomy and technical tools such as intraoperative ultrasound/near infrared fluorescence imaging with ICG. SOURCE OF Funding: None
