Hand-assisted laparoscopic radical nephrectomy in pregnancy

Area of Science:

• Urology
• Surgical Oncology
• Maternal-Fetal Medicine

Background:

• Renal cell carcinoma (RCC) during pregnancy presents unique management challenges.
• Delayed treatment of aggressive renal tumors can lead to fatal maternal outcomes.
• Hand-assisted laparoscopic nephrectomy offers a potentially safer alternative to open surgery in pregnant patients.

Observation:

• A 32-year-old pregnant woman at 20 weeks gestation underwent successful hand-assisted laparoscopic transperitoneal nephrectomy for a 61 × 41 mm chromophobe RCC.
• The procedure was well-tolerated by both mother and fetus, with no intraoperative complications.
• The patient had an uneventful postoperative recovery, a normal vaginal delivery at term, and remained tumor-free at 34-month follow-up.

Findings:

• Hand-assisted laparoscopic nephrectomy is a feasible and safe surgical option for treating renal cell carcinoma during pregnancy.
• This minimally invasive approach facilitated a faster and safer procedure, crucial for maternal and fetal well-being.
• Early diagnosis and timely surgical intervention are critical to prevent adverse cancer-related outcomes in pregnant patients with aggressive renal tumors.

Implications:

• This case highlights the importance of considering timely surgical intervention for renal tumors during pregnancy, even with aggressive histology.
• Hand-assisted laparoscopy may be advantageous over pure laparoscopic techniques in pregnant patients, particularly in the second and third trimesters.
• Renal biopsy can aid in assessing tumor malignancy and guiding treatment decisions, balancing maternal health and fetal safety.