ROBOTIC ASSISTED PARTIAL NEPHRECTOMY AND PLEDGETED RENORAPHY

Aims: Partial nephrectomy represents the standard treatment for small renal masses. Currently, it is commonly performed using minimally invasive approaches, but one of the main concerns still remain the achievement of good hemostasis and the closing of parenchymal defect. Robotic assistance, thanks to the well-known versatility, allows to safely perform these procedures, also in difficult cases, that have so far been treated by an open approach. We are presenting a case of robotic assisted partial nephrectomy and pledgeted suture for the parenchymal defect performed with the use of da Vinci Xi. Materials and Methods: A 48-year-old woman with an incidental US finding of a 50mm partially exophytic tumor of the superior pole of the left kidney, confirmed with CT scan, was operated with the da Vinci Xi® platform. Patient was positioned in right lateral decubitus with the trocars’ disposition for the "upper left quadrants" suggested by the Intuitive. Results: The procedure was successfully completed in 185 min. The partial nephrectomy was performed following the isolation and clamping of an upper renal vein and artery for the superior pole of the kidney. For the improvement of hemostasis and the closure of parenchymal defect, we used five PTFE pledgets anchored with V-Loc sutures. There were no surgical complications or need for conversion to laparoscopy or laparotomy. The patient had an uneventful recovery and she was discharged on the 3rd postoperative day. Conclusions: The use of robotic assistance, allows to perform complex partial nephrectomies with a total minimally invasive technique. Moreover, it has the advantage of transferring and easily apply to the minimally invasive surgery field the use of adjunctive techniques borrowed from open procedures for achieving hemostasis and closing parenchymal defects, such as the pledgeted renoraphy.