V05-03: Clampless and Sutureless Robot-Assisted Partial Nephrectomy for the Treatment of Fifteen Bilateral Renal Lesions in a Patient with Von Hippel-Lindau Syndrome.
Introduction: Patients with Von Hippel-Lindau (VHL) disease have higher risk of developing renal cell carcinomas. In these patients, given the frequent presence of multiple masses and the high risk of recurrence, nephron-sparing approaches are essential to preserve renal function. In this context, technical refinements such as 3D reconstruction, off-clamp, selective suturing or sutureless techniques can be helpful to improve functional outcomes. Herein, we described our surgical management for a patient with VHL syndrome with multiple bilateral renal lesions applying these innovative techniques. Methods: A 27-year-old man affected by VHL disease presented with 8 and 7 masses on the right and left kidney, respectively. Diameters ranged from 5 to 54 mm on the right, and from 4 on 57 mm on the left. His baseline creatinine was 1.11 mg/dl. First, the patient underwent a left RAPN which revealed 5 clear cell renal cell carcinomas (ccRCC) – the biggest one pT1bR0 – and 2 benign cysts. Six weeks later, the patient underwent a right RAPN. Both procedures were performed using a clampless and sutureless technique; when a completely sutureless resection was not possible, a selective suturing technique was utilised. Preoperative surgical planning included 3-D imaging reconstruction. We here described the surgical procedure for right RAPN and its peri- and post-operative outcomes. Results: Operative and console time were 205 and 175 minutes, respectively. Blood loss was 650 ml. An off-clamp enucleation of all 8 renal masses was performed with a sutureless technique, applying an haemostatic agent (Veriset) to the resection beds. Only for the biggest lower pole mass a selective suture was required in the resection bed. There was no need for intra-operative transfusions, and no perioperative complications occurred. The patient was discharged on the second postoperative day with a creatinine of 0.99 mg/dL. The pathologic assessment revealed 8 ccRCC, the biggest one being pT1bR0. Conclusions: In patients with multiple renal masses requiring surgical treatment, the use of innovative approaches such as clampless approach, sutureless and/or selective suturing techniques can help preserving healthy parenchyma during RAPN. Further studies with longer functional follow-up are awaited to confirm these findings at long-term. SOURCE OF Funding: None
